Provider Demographics
NPI:1689671174
Name:LOVATO, JOSEPH MARIO (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARIO
Last Name:LOVATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 RIO TRUMPEROS CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5333
Mailing Address - Country:US
Mailing Address - Phone:505-280-7370
Mailing Address - Fax:505-358-3787
Practice Address - Street 1:4425 RIO TRUMPEROS COURT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5333
Practice Address - Country:US
Practice Address - Phone:505-280-7370
Practice Address - Fax:505-358-3787
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-320207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9136Medicaid
G81433Medicare UPIN
342315000Medicare PIN
NM34231500Medicare PIN
NMG81433Medicare UPIN