Healthcare Provider Details

I. General information

NPI: 1255619706
Provider Name (Legal Business Name): LOYALTY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 N FEDERAL HWY
POMPANO BEACH FL
33064-6042
US

IV. Provider business mailing address

3931 N FEDERAL HWY
POMPANO BEACH FL
33064-6042
US

V. Phone/Fax

Practice location:
  • Phone: 954-532-5795
  • Fax: 954-532-5747
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIO NASCIMENTO
Title or Position: MANAGER
Credential:
Phone: 954-993-6727