Healthcare Provider Details

I. General information

NPI: 1316898893
Provider Name (Legal Business Name): CITLALLY NICOL LOPEZ-FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SHADOW LN, LAS VEGAS, NV 89106
LAS VEGAS NV
89106
US

IV. Provider business mailing address

3237 BRAZOS ST
LAS VEGAS NV
89169-3204
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-3011
  • Fax:
Mailing address:
  • Phone: 702-499-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: