MEDICARE: LOYALTY MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1740048453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYALTY MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	2977 GOODLETTE-FRANK RD N STE 1
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-4613
Country	:	US
Telephone Number	:	239-331-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2977 GOODLETTE-FRANK RD N STE 1
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-4613
Country	:	US
Telephone Number	:	239-331-4999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARITZA REYES MARTI
Credential	:	APRN,FNP-BC
Telephone Number	:	239-331-4999

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	01/27/2025

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