Provider Demographics
NPI:1740997220
Name:LOVE FIELD CLINIC PLANO LLC
Entity type:Organization
Organization Name:LOVE FIELD CLINIC PLANO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:469-277-8858
Mailing Address - Street 1:2300 14TH ST STE 145
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6445
Mailing Address - Country:US
Mailing Address - Phone:469-277-8858
Mailing Address - Fax:469-001-9543
Practice Address - Street 1:2300 14TH ST STE 145
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6445
Practice Address - Country:US
Practice Address - Phone:469-277-8858
Practice Address - Fax:469-001-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty