Healthcare Provider Details

I. General information

NPI: 1922140532
Provider Name (Legal Business Name): PEDRO FLORES RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-1000
US

IV. Provider business mailing address

PO BOX 798
ROCKVILLE CENTRE NY
11571-0798
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-1353
  • Fax:
Mailing address:
  • Phone: 516-705-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: