Provider Demographics
NPI:1669093332
Name:LOFFREDO, GARY ROCCO
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROCCO
Last Name:LOFFREDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W COMMERCIAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3413
Mailing Address - Country:US
Mailing Address - Phone:954-396-1541
Mailing Address - Fax:
Practice Address - Street 1:3313 W COMMERCIAL BLVD STE 130
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3413
Practice Address - Country:US
Practice Address - Phone:954-396-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994518251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health