Provider Demographics
NPI:1497096879
Name:LOERA, EFRAIN GUILLERMO JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:GUILLERMO
Last Name:LOERA
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15802 N. PARK VIEW PLACE
Mailing Address - Street 2:DYSART UNIFIED SCHOOL DISTRICT
Mailing Address - City:SUPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-876-7063
Mailing Address - Fax:623-523-8461
Practice Address - Street 1:15802 N. PARKVIEW PLACE
Practice Address - Street 2:DYSART UNIFIED SCHOOL DISTRICT
Practice Address - City:SUPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-876-7063
Practice Address - Fax:623-523-8461
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP048604164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse