Provider Demographics
NPI:1619944642
Name:LOVELLO, DAMIAN J (IDC)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:J
Last Name:LOVELLO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 IH 37
Mailing Address - Street 2:APT 502
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3353
Mailing Address - Country:US
Mailing Address - Phone:361-385-6216
Mailing Address - Fax:
Practice Address - Street 1:1632 TICONDEROGA ST
Practice Address - Street 2:USS HERON MHC 52
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362
Practice Address - Country:US
Practice Address - Phone:361-385-6216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710I1002XOtherINDEPENDANT DUTY CORPSMAN