Provider Demographics
NPI:1861818908
Name:LOVATO, NATIVIDAD
Entity Type:Individual
Prefix:
First Name:NATIVIDAD
Middle Name:
Last Name:LOVATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SIPAPU ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6489
Mailing Address - Country:US
Mailing Address - Phone:575-758-5857
Mailing Address - Fax:
Practice Address - Street 1:111 PASEO DEL CANON W
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-8218
Practice Address - Country:US
Practice Address - Phone:575-758-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator