Healthcare Provider Details

I. General information

NPI: 1578481495
Provider Name (Legal Business Name): DAVID LOVELADY HAD00773
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RODEO RD
SANTA FE NM
87507-4837
US

IV. Provider business mailing address

1708 PASEO DE PERALTA UNIT B
SANTA FE NM
87501-3764
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-1847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0773
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: