Healthcare Provider Details

I. General information

NPI: 1043201114
Provider Name (Legal Business Name): TINA MARIE LOAYZA F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

IV. Provider business mailing address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-8450
  • Fax: 805-474-7169
Mailing address:
  • Phone: 805-474-8450
  • Fax: 805-474-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number178245
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP17203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: