Healthcare Provider Details

I. General information

NPI: 1568998755
Provider Name (Legal Business Name): CHRISTINA MONIQUE FLORES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N BOULDER HWY
HENDERSON NV
89011-4120
US

IV. Provider business mailing address

705 TAZA VERDE AVE
NORTH LAS VEGAS NV
89031-2396
US

V. Phone/Fax

Practice location:
  • Phone: 702-558-8600
  • Fax:
Mailing address:
  • Phone: 213-318-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN16713
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number287491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: