Provider Demographics
NPI:1467541532
Name:LOVELESS, ELLIN (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:ELLIN
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56970 YUCCA TRL
Mailing Address - Street 2:#102
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3753
Mailing Address - Country:US
Mailing Address - Phone:760-365-0691
Mailing Address - Fax:760-365-0692
Practice Address - Street 1:56970 YUCCA TRL
Practice Address - Street 2:#102
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3753
Practice Address - Country:US
Practice Address - Phone:760-365-0691
Practice Address - Fax:760-365-0692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 1932237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ45183ZOtherBS OF CALIFORNIA
CAZZZ71937ZOtherMEDI-CAL PROVIDER