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General NPI Number Information
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NPI Number | 1609662899
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Entity Type | Individual
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Provider Name | LUC LOYOLA
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone | 860-679-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 13108 TIFTON DR
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City | TAMPA
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State | FL
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Zip | 33618-3020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 14383
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License Number State | CT
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