| Loyola Family Health Center Professional Corporation | |
|
4225 Tweedy Blvd South Gate CA 90280-6217 | |
| (323) 564-6464 | |
| (323) 564-8578 |
| Full Name | Loyola Family Health Center Professional Corporation |
|---|---|
| Speciality | General Practice |
| Location | 4225 Tweedy Blvd, South Gate, California |
| Authorized Official Name and Position | Alejandro Lazaro Gonzalez (OWNER) |
| Authorized Official Contact | 6266641279 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loyola Family Health Center Professional Corporation 4225 Tweedy Blvd Ste B South Gate CA 90280-6217 Ph: (323) 564-6464 | Loyola Family Health Center Professional Corporation 4225 Tweedy Blvd South Gate CA 90280-6217 Ph: (323) 564-6464 |
| NPI Number | 1760947451 |
|---|---|
| Provider Enumeration Date | 02/06/2019 |
| Last Update Date | 12/01/2020 |
| Medicare PECOS PAC ID | 3072925023 |
|---|---|
| Medicare Enrollment ID | O20201215002536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760947451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Alejandro Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538108097 PECOS PAC ID: 9830007152 Enrollment ID: I20080229000534 |
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