Provider Demographics
NPI:1316699085
Name:LOVING CARE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:LOVING CARE MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALDES ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-471-2171
Mailing Address - Street 1:2275 WESTPARK CT STE 100
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3992
Mailing Address - Country:US
Mailing Address - Phone:817-933-2870
Mailing Address - Fax:817-394-4345
Practice Address - Street 1:2275 WESTPARK CT STE 100
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3992
Practice Address - Country:US
Practice Address - Phone:817-933-2870
Practice Address - Fax:817-394-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477786465OtherNPI