Provider Demographics
NPI:1558755041
Name:LOYALTY CARE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LOYALTY CARE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONCLUS BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-896-9787
Mailing Address - Street 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 460-8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:305-896-9787
Mailing Address - Fax:305-503-4684
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 460-8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-896-9787
Practice Address - Fax:305-503-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service