Healthcare Provider Details

I. General information

NPI: 1689644619
Provider Name (Legal Business Name): EUSEBIO FLORES III PA-C, MPAS, M ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BHC ATSUGI PSC 477 BOX 2
ATSUGI JAPAN
FPO AP 96306
JP

IV. Provider business mailing address

BHC ATSUGI PSC 477 BOX 2
ATSUGI JAPAN
FPO AP 96306
JP

V. Phone/Fax

Practice location:
  • Phone: 01181467634693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: