Provider Demographics
NPI:1912052499
Name:LOVETON, POLLY C (PA-C)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:C
Last Name:LOVETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:C
Other - Last Name:LOVETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-760-0190
Mailing Address - Fax:949-760-0439
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-760-0190
Practice Address - Fax:949-760-0439
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17902363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical