Healthcare Provider Details

I. General information

NPI: 1043313497
Provider Name (Legal Business Name): ANGEL ENRIQUE FLORES LOPEZ RRT,PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VISTAS DE RIO GRANDE 2 CALLE TABONUCO #449
RIO GRANDE PR
00745
US

IV. Provider business mailing address

VISTAS DE RIO GRANDE 2 CALLE TABONUCO #449
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-672-0020
  • Fax:
Mailing address:
  • Phone: 787-672-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1411
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number1333
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: