Basic Information
| Provider Information | |||||||||
| NPI: | 1386640092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVELL | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1500 EXPO PKWY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958154227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166468300 | ||||||||
| FaxNumber: | 9169204434 | ||||||||
| Practice Location | |||||||||
| Address1: | 885 RUSSELL BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956163426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307561450 | ||||||||
| FaxNumber: | 5307561602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0204X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0205X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085U0001X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | A74619 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | A74619 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
No ID Information.