Provider Demographics
NPI:1407960552
Name:MANOCHA, LOVELESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:LOVELESH
Middle Name:K
Last Name:MANOCHA
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 1:124 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1202
Mailing Address - Country:US
Mailing Address - Phone:210-224-1771
Mailing Address - Fax:210-229-9138
Practice Address - Street 1:124 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1202
Practice Address - Country:US
Practice Address - Phone:210-224-1771
Practice Address - Fax:210-229-9138
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042049901Medicaid
TX042049901Medicaid
TX8340J0Medicare ID - Type Unspecified