Provider Demographics
NPI:1003923368
Name:LOVELL, ALLISON ANN (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:LOVELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ANN
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:ELCCC 2ND FLOOR
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-773-1451
Mailing Address - Fax:760-773-1239
Practice Address - Street 1:1555 S PALM CANYON DR BLDG C
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-8354
Practice Address - Country:US
Practice Address - Phone:760-773-4560
Practice Address - Fax:760-773-4561
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45444207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11900FMedicaid
CAFHC11900FMedicaid