Healthcare Provider Details

I. General information

NPI: 1437725843
Provider Name (Legal Business Name): DASHILA MARIE FLORES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INDUSTRIAL PARK LAS FLORES CARR 3 KM 23.9
CAROLINA PR
00745
US

IV. Provider business mailing address

PO BOX 9809
CAGUAS PR
00726-9809
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax:
Mailing address:
  • Phone: 787-704-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6777
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: