Provider Demographics
NPI:1376317438
Name:LOVE, TARA DEAN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DEAN
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SMITH ST # 61070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-2714
Mailing Address - Country:US
Mailing Address - Phone:346-577-4667
Mailing Address - Fax:
Practice Address - Street 1:700 SMITH ST#61070
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-3981
Practice Address - Country:US
Practice Address - Phone:346-577-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist