Provider Demographics
NPI:1376610923
Name:LOVATO, ESTEBAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:DANIEL
Last Name:LOVATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 INTERNATIONAL BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2226
Mailing Address - Country:US
Mailing Address - Phone:510-261-1677
Mailing Address - Fax:510-261-1650
Practice Address - Street 1:3022 INTERNATIONAL BLVD STE 312
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2226
Practice Address - Country:US
Practice Address - Phone:510-261-1677
Practice Address - Fax:510-261-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF48859Medicare UPIN