NPIMap

Organization Active NPI

Loyal Source Government Services

  • Health Maintenance Organization
  • Orlando, FL
National Provider Identifier
1487053864
Registry record updated Aug 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
95000947 Issued in CA
Legal business name
LOYAL SOURCE GOVERNMENT SERVICES
Practice address
3680 Avalon Park East Blvd Ste 310
Orlando, FL 32828-9374
Phone
(407) 381-7734
NPI assigned
Aug 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Gambala, NP
Title
MSN, FNP-C
Phone
(619) 301-9112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 95000947 CA Primary

Addresses

Primary practice location

3680 Avalon Park East Blvd Ste 310
Orlando, FL 32828-9374

Mailing address

900 Rigley St
Chula Vista, CA 91911-7003
Phone (619) 301-9112

Other identifiers 1

IdentifierTypeStateIssuer
95000947MedicaidCA

Other names 1

  • Loyal Source Government Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Community Care Services456 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3680 E Avalon Park Blvd
Ste 310
Orlando, FL 32828
Phone (407) 284-4362

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408579200000",
    "number": "1487053864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RIGLEY ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919117003",
            "telephone_number": "619-301-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 AVALON PARK EAST BLVD STE 310",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328289374",
            "telephone_number": "407-381-7734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOYAL SOURCE GOVERNMENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-08-21",
        "status": "A",
        "authorized_official_last_name": "GAMBALA",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "MSN, FNP-C",
        "authorized_official_telephone_number": "619-301-9112",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "95000947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95000947",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loyal Source Government Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.