Healthcare Provider Details

I. General information

NPI: 1154353183
Provider Name (Legal Business Name): ERNEST FLORES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7260
  • Fax: 575-522-1355
Mailing address:
  • Phone: 575-522-7260
  • Fax: 575-522-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84-180
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: