Healthcare Provider Details

I. General information

NPI: 1629328760
Provider Name (Legal Business Name): WILFREDO FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BEECH ST
NEWLAND NC
28657-9670
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 828-733-5889
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: