Provider Demographics
NPI:1164290086
Name:LOVATO, JASON (ATP,CRTS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:LOVATO
Suffix:
Gender:M
Credentials:ATP,CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 ANAHEIM AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1580
Mailing Address - Country:US
Mailing Address - Phone:505-259-6093
Mailing Address - Fax:505-355-6991
Practice Address - Street 1:11436 ROJAS DR STE B6
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6488
Practice Address - Country:US
Practice Address - Phone:505-259-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14722225CA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier