Basic Information
Provider Information
NPI: 1740805688
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOVISA
FirstName: LINDSAY
MiddleName: ROBIN
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3230 WARING CT STE A
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920564509
CountryCode: US
TelephoneNumber: 7603057528
FaxNumber: 7605094410
Practice Location
Address1: 3230 WARING CT STE A
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920564509
CountryCode: US
TelephoneNumber: 7603057528
FaxNumber: 7605094410
Other Information
ProviderEnumerationDate: 06/16/2020
LastUpdateDate: 06/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WA0400X95083077CAY Nursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)

No ID Information.


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