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General NPI Number Information
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NPI Number | 1700343183
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Entity Type | Individual
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Provider Name | PHILLIP LOVING
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Gender | Male
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 5500 UNIVERSITY PKWY # CE-120
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-2318
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Country | US
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Telephone | 909-537-3616
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Fax | 909-922-7580
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Provider Business Mailing Address
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Address Line | 5500 UNIVERSITY PKWY # CE-120
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-2318
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Country | US
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Telephone | 909-537-3616
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Fax | 909-922-7580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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Taxonomy #4
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Taxonomy Code | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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Taxonomy #5
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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