Healthcare Provider Details

I. General information

NPI: 1750578159
Provider Name (Legal Business Name): FLORES CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W JACKSON AVE
LOVINGTON NM
88260-3302
US

IV. Provider business mailing address

PO BOX 1412 828 W JACKSON
LOVINGTON NM
88260-1412
US

V. Phone/Fax

Practice location:
  • Phone: 505-396-2474
  • Fax: 505-396-5521
Mailing address:
  • Phone: 505-396-2474
  • Fax: 505-396-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberA504-68
License Number StateNM

VIII. Authorized Official

Name: DR. WALTER FLORES
Title or Position: GENERAL PRACTICE
Credential: D.O.
Phone: 505-396-2474