Healthcare Provider Details

I. General information

NPI: 1316699085
Provider Name (Legal Business Name): LOVING CARE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 WESTPARK CT STE 100
EULESS TX
76040-3992
US

IV. Provider business mailing address

2275 WESTPARK CT STE 100
EULESS TX
76040-3992
US

V. Phone/Fax

Practice location:
  • Phone: 817-933-2870
  • Fax: 817-394-4345
Mailing address:
  • Phone: 817-933-2870
  • Fax: 817-394-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANA I VALDES ROQUE
Title or Position: MD, OWNER
Credential: MD
Phone: 817-471-2171