Provider Demographics
NPI:1417690603
Name:LOVING, DUSTIN JANARIO
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JANARIO
Last Name:LOVING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:JANARIO
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3652 MICHELSON DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1727
Mailing Address - Country:US
Mailing Address - Phone:949-474-1493
Mailing Address - Fax:
Practice Address - Street 1:3652 MICHELSON DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1727
Practice Address - Country:US
Practice Address - Phone:949-474-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician