Healthcare Provider Details

I. General information

NPI: 1508196395
Provider Name (Legal Business Name): ELEAZAR FLORES LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELI FLORES

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30715 GINGER TRACE DR
SPRING TX
77386
US

IV. Provider business mailing address

30715 GINGER TRACE DR
SPRING TX
77386-4021
US

V. Phone/Fax

Practice location:
  • Phone: 281-210-9934
  • Fax:
Mailing address:
  • Phone: 281-210-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: