Provider Demographics
NPI:1932377165
Name:LA LOMA MEDICAL GROUP, INC. 2
Entity type:Organization
Organization Name:LA LOMA MEDICAL GROUP, INC. 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-261-1677
Mailing Address - Street 1:3022 INTERNATIONAL BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2226
Mailing Address - Country:US
Mailing Address - Phone:510-261-1677
Mailing Address - Fax:510-261-1650
Practice Address - Street 1:10 E CHARTER WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-1357
Practice Address - Country:US
Practice Address - Phone:209-460-1900
Practice Address - Fax:209-460-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty