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General NPI Number Information
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NPI Number | 1245583426
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Entity Type | Organization
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Legal Business Name | LOVING CARE GROUP LLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 2213 MARTIN DRIVE
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City | BEDFORD
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State | TX
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Zip | 76021
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Country | US
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Telephone | 817-876-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 N STATE HIGHWAY 360 APT 535
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-7842
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Country | US
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Telephone | 817-471-2171
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANA I VALDES ROQUE
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Credential | MD
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Telephone | 817-933-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N4176
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License Number State | TX
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