Provider Demographics
NPI:1003441817
Name:LOERA, JESSICA M
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:LOERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BALCHSPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180
Mailing Address - Country:US
Mailing Address - Phone:972-978-2688
Mailing Address - Fax:
Practice Address - Street 1:14807 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:BALCHSPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180
Practice Address - Country:US
Practice Address - Phone:972-978-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider