Provider Demographics
NPI:1366687469
Name:LOVE, LESTER EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:EUGENE
Last Name:LOVE
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 1:520 E TULARE AVE
Mailing Address - Street 2:VISALIA ADULT INTEGRATED CLINIC
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-3629
Mailing Address - Country:US
Mailing Address - Phone:559-623-0900
Mailing Address - Fax:559-733-0349
Practice Address - Street 1:520 E TULARE AVE
Practice Address - Street 2:VISALIA ADULT INTEGRATED CLINIC
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3629
Practice Address - Country:US
Practice Address - Phone:559-623-0900
Practice Address - Fax:559-733-0349
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-11-10
Deactivation Date:2008-11-20
Deactivation Code:
Reactivation Date:2008-12-04
Provider Licenses
StateLicense IDTaxonomies
CAA700952084A0401X, 2084P0802X, 207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI42227Medicare UPIN