Basic Information
Provider Information
NPI: 1790924439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOVEDAY-LAGHI
FirstName: VIVIAN
MiddleName: MARGARET
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1324 LAKELAND HILLS BLVD
Address2: ATTN: MANAGED CARE DEPT.
City: LAKELAND
State: FL
PostalCode: 338054543
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1324 LAKELAND HILLS BLVD
Address2:  
City: LAKELAND
State: FL
PostalCode: 338054543
CountryCode: US
TelephoneNumber: 8636871321
FaxNumber: 8636036534
Other Information
ProviderEnumerationDate: 02/19/2009
LastUpdateDate: 12/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2300XME110406FLN Ambulatory Health Care FacilitiesClinic/CenterPrimary Care
207R00000XME 110406FLN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XME110406FLY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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