Provider Demographics
NPI:1730280710
Name:LOVATO, GAETH ANDREW JR (PA)
Entity Type:Individual
Prefix:
First Name:GAETH
Middle Name:ANDREW
Last Name:LOVATO
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47600 VIA MONTESSA
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2134
Mailing Address - Country:US
Mailing Address - Phone:760-413-7258
Mailing Address - Fax:
Practice Address - Street 1:47600 VIA MONTESSA
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2134
Practice Address - Country:US
Practice Address - Phone:760-413-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17005363AM0700X, 363AS0400X
CA17005363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17005OtherCA LICENSE #
CAPA17005OtherCA LICENSE #
CAS97490Medicare UPIN