Provider Demographics
NPI:1750596920
Name:LOVATO, BENJAMIN (CST)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LOVATO
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 W MCDOWELL RD
Mailing Address - Street 2:STE 302
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2624
Mailing Address - Country:US
Mailing Address - Phone:623-882-1292
Mailing Address - Fax:623-882-8184
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:STE 302
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2624
Practice Address - Country:US
Practice Address - Phone:623-882-1292
Practice Address - Fax:623-882-8184
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist