Provider Demographics
NPI:1477388502
Name:LOVATO-PESINA, JONATHAN MARCUS
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARCUS
Last Name:LOVATO-PESINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 ADAMS ST NE APT D31
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8047
Mailing Address - Country:US
Mailing Address - Phone:505-814-3719
Mailing Address - Fax:
Practice Address - Street 1:3299 ADAMS ST NE APT D31
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8047
Practice Address - Country:US
Practice Address - Phone:505-814-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician