Healthcare Provider Details

I. General information

NPI: 1861835589
Provider Name (Legal Business Name): CARLA J LOVELACE CST/CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK CENTRAL 814
MCKINNEY TX
75069-7947
US

IV. Provider business mailing address

1701 PARK CENTRAL 814
MCKINNEY TX
75069-7947
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-7895
  • Fax:
Mailing address:
  • Phone: 972-801-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number246ZC0007X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: