Healthcare Provider Details

I. General information

NPI: 1073123428
Provider Name (Legal Business Name): ALEXANDRA FLORES RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 LAKEVILLE DR STE 304
KINGWOOD TX
77339-2694
US

IV. Provider business mailing address

2827 SILVER FALLS DR
KINGWOOD TX
77339-1997
US

V. Phone/Fax

Practice location:
  • Phone: 281-305-0411
  • Fax:
Mailing address:
  • Phone: 281-705-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number754054
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: