Provider Demographics
NPI:1710709456
Name:LOVATO, ANGEL MARIE (BEHAVIOR TECH III)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:LOVATO
Suffix:
Gender:F
Credentials:BEHAVIOR TECH III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 CENTRAL AVE NW TRLR 60
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2119
Mailing Address - Country:US
Mailing Address - Phone:505-620-8666
Mailing Address - Fax:
Practice Address - Street 1:7501 CENTRAL AVE NW
Practice Address - Street 2:TRLR 60
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121
Practice Address - Country:US
Practice Address - Phone:505-620-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician