Healthcare Provider Details

I. General information

NPI: 1154276129
Provider Name (Legal Business Name): LOYALTY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14145 SW 119TH AVE
MIAMI FL
33186-6013
US

IV. Provider business mailing address

PO BOX 343103
HOMESTEAD FL
33034-0103
US

V. Phone/Fax

Practice location:
  • Phone: 305-720-8562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARMEN CARIDAD LEAL DIAZ
Title or Position: OWNER & MANAGING MEMBER
Credential: APRN, FNP, PMHNP-BC
Phone: 305-244-6868