Provider Demographics
NPI:1215114426
Name:LOVERSO, ELIZABETH ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:LOVERSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 VIA PALMERA
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4394
Mailing Address - Country:US
Mailing Address - Phone:812-470-1745
Mailing Address - Fax:
Practice Address - Street 1:31755 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3101
Practice Address - Country:US
Practice Address - Phone:760-770-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001881363AS0400X
CAPA61570363A00000X
IN10001974A363AS0400X
IA00610213E00000X
NC0010-08736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist