Organization
LOYAL SOURCE GOVERNMENT SERVICES
Active
Other names
Loyal Source Government Services
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA GAMBALA NP (MSN, FNP-C)
(619) 301-9112
Entity
Organization
Contact information
Practice address
3680 AVALON PARK EAST BLVD STE 310, ORLANDO, FL 32828-9374
(407) 381-7734
Mailing address
900 RIGLEY ST, CHULA VISTA, CA 91911-7003
(619) 301-9112
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
95000947
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95000947
—
CA
Enumeration date
08/21/2014
Last updated
08/21/2014
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