Healthcare Provider Details

I. General information

NPI: 1124196316
Provider Name (Legal Business Name): NIRMA IRIS FLORES MT LIC 1894
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COMERCIO 14
MOROVIS PR
00687
US

IV. Provider business mailing address

PO BOX 427
MOROVIS PR
00687
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-4230
  • Fax: 787-862-4230
Mailing address:
  • Phone: 787-862-4230
  • Fax: 787-862-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number1894
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: