Provider Demographics
NPI:1912435942
Name:LOYOLA HERRERA, GRETEL (BA)
Entity Type:Individual
Prefix:MS
First Name:GRETEL
Middle Name:
Last Name:LOYOLA HERRERA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 FONTAINEBLEAU BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5552
Mailing Address - Country:US
Mailing Address - Phone:786-707-8543
Mailing Address - Fax:
Practice Address - Street 1:8323 NW 12TH ST STE 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1840
Practice Address - Country:US
Practice Address - Phone:305-373-3424
Practice Address - Fax:305-373-3474
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-50658103K00000X
261QM0801X, 251B00000X, 101YM0800X, 101YS0200X, 106S00000X, 171M00000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019640500Medicaid