Provider Demographics
NPI:1619346582
Name:LOVE, ANGELA M.
Entity Type:Organization
Organization Name:LOVE, ANGELA M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RMA,BS, MBA PARTIAL
Authorized Official - Phone:909-231-8743
Mailing Address - Street 1:8816 FOOTHILL BLVD # 103-238
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-231-8743
Mailing Address - Fax:
Practice Address - Street 1:8816 FOOTHILL BLVD # 103-238
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7199
Practice Address - Country:US
Practice Address - Phone:909-231-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA247ZC0005XOtherBUPA
CA207SC0300XMedicaid
CA247ZC0005XOtherCOVERED CALIFORNIA
CA291U00000XOtherMEDICARE
CA247ZC0005XOtherUNITED HEALTHCARE
CA247ZC0005XMedicaid
CA247ZC0005XMedicare UPIN