Healthcare Provider Details

I. General information

NPI: 1861446742
Provider Name (Legal Business Name): LISA ESTELLE FLORES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W 9TH ST
CHESTER PA
19013-2040
US

IV. Provider business mailing address

2600 W 9TH ST 2 NORTH
CHESTER PA
19013-2040
US

V. Phone/Fax

Practice location:
  • Phone: 610-859-2059
  • Fax: 610-859-8217
Mailing address:
  • Phone: 610-485-3800
  • Fax: 610-485-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039845E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: