Provider Demographics
NPI:1215346051
Name:LOOP FAMILY, LLC
Entity type:Organization
Organization Name:LOOP FAMILY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-7655
Mailing Address - Street 1:7902 NW 36TH ST
Mailing Address - Street 2:#209
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6637
Mailing Address - Country:US
Mailing Address - Phone:305-477-7655
Mailing Address - Fax:
Practice Address - Street 1:7902 NW 36TH ST
Practice Address - Street 2:#209
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6637
Practice Address - Country:US
Practice Address - Phone:305-477-7655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty