Healthcare Provider Details

I. General information

NPI: 1881744498
Provider Name (Legal Business Name): KIMBERLY K LOVATO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SE BASELINE ST
HILLSBORO OR
97123-4244
US

IV. Provider business mailing address

190 SE 8TH AVE # A-201
HILLSBORO OR
97123-4216
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-7333
  • Fax: 971-266-2956
Mailing address:
  • Phone: 503-352-7333
  • Fax: 971-266-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01186
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01186
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: