Healthcare Provider Details

I. General information

NPI: 1326037763
Provider Name (Legal Business Name): MIRNA L FLORES SANTIAGO RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65TH INFANTERIA SAN JUAN AGING CENTER/COMPLEJO MEDICO SOCIAL ANTILLAS
RIO PIEDRAS PR
00983
US

IV. Provider business mailing address

PO BOX 3022
CAROLINA PR
00984-3022
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number0280
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number0280
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0280
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: