Healthcare Provider Details

I. General information

NPI: 1295754166
Provider Name (Legal Business Name): WILLIAM DOMINGO FLORES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 SAINT CLAIR AVE NE
CLEVELAND OH
44114-2004
US

IV. Provider business mailing address

1530 SAINT CLAIR AVE NE
CLEVELAND OH
44114-2004
US

V. Phone/Fax

Practice location:
  • Phone: 216-535-9100
  • Fax: 216-298-5015
Mailing address:
  • Phone: 216-535-9100
  • Fax: 216-298-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.007917RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: