Healthcare Provider Details

I. General information

NPI: 1477022507
Provider Name (Legal Business Name): LACE LOYOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

590 B ST
HAYWARD CA
94541-5004
US

V. Phone/Fax

Practice location:
  • Phone: 925-655-3178
  • Fax:
Mailing address:
  • Phone: 510-247-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: