Provider Demographics
NPI:1841029675
Name:LORETO, IVETTE (LMT)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:LORETO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 10TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-3940
Mailing Address - Country:US
Mailing Address - Phone:520-222-7385
Mailing Address - Fax:866-727-9116
Practice Address - Street 1:312 W 10TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3940
Practice Address - Country:US
Practice Address - Phone:520-222-7385
Practice Address - Fax:866-727-9116
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist