Healthcare Provider Details

I. General information

NPI: 1457812794
Provider Name (Legal Business Name): ANDRE LOYOLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CHRISTOPHER COLUMBUS DR PH 6
JERSEY CITY NJ
07302-5726
US

IV. Provider business mailing address

26471 MAPLE AVE
LOMA LINDA CA
92354-6709
US

V. Phone/Fax

Practice location:
  • Phone: 951-237-3610
  • Fax:
Mailing address:
  • Phone: 951-237-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number323272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: