Healthcare Provider Details

I. General information

NPI: 1902391253
Provider Name (Legal Business Name): KEISHLA ANAIS FLORES HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA SUITE 412 CONDOMINIO SAN VICENTE
PONCE PR
00717-1567
US

IV. Provider business mailing address

8169 CALLE CONCORDIA SUITE 412 CONDOMINIO SAN VICENTE
PONCE PR
00717-1567
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax: 787-284-5874
Mailing address:
  • Phone: 787-284-5884
  • Fax: 787-284-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number85988
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: