Provider Demographics
NPI:1760947451
Name:LOYOLA FAMILY HEALTH CENTER PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LOYOLA FAMILY HEALTH CENTER PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-664-1279
Mailing Address - Street 1:4225 TWEEDY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6217
Mailing Address - Country:US
Mailing Address - Phone:323-564-6464
Mailing Address - Fax:323-564-8578
Practice Address - Street 1:4225 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6217
Practice Address - Country:US
Practice Address - Phone:323-564-6464
Practice Address - Fax:323-564-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty