Healthcare Provider Details

I. General information

NPI: 1205350261
Provider Name (Legal Business Name): CYNTHIA FLORES BORDERS RDN, LDN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 5TH ST
SUNSET BEACH NC
28468-4009
US

IV. Provider business mailing address

PO BOX 7450
OCEAN ISLE BEACH NC
28469-1450
US

V. Phone/Fax

Practice location:
  • Phone: 979-777-1158
  • Fax:
Mailing address:
  • Phone: 979-777-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005252
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number39539-DIE-0
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1949
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: