Provider Demographics
NPI:1285963983
Name:LOVELACE, STEWART (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 OCEAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5448
Mailing Address - Country:US
Mailing Address - Phone:310-376-1415
Mailing Address - Fax:310-545-1323
Practice Address - Street 1:1112 OCEAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5448
Practice Address - Country:US
Practice Address - Phone:310-376-1415
Practice Address - Fax:310-545-1323
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC302632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry