Organization
LOVING CARE GROUP LLC
Active
Other names
Pediatrics Palace of DFW
Organization subpart
No
Provider details
NPI number
Authorized official
ANA I VALDES ROQUE MD (MANAGING MEMBER)
(817) 933-2840
Entity
Organization
Contact information
Practice address
2213 MARTIN DRIVE, BEDFORD, TX 76021
(817) 876-6113
Mailing address
2825 N STATE HIGHWAY 360, APT 535, GRAND PRAIRIE, TX 75050-7842
(817) 471-2171
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N4176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477786465
—
TX
Enumeration date
10/25/2012
Last updated
01/22/2013
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