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General NPI Number Information
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NPI Number | 1124713292
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Entity Type | Individual
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Provider Name | PAUL FLORES PHD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 200 W MONROE ST STE 308
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3997
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Country | US
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Telephone | 309-204-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 1348 BERKLEY RD
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City | NORMAL
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State | IL
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Zip | 61761-9550
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Country | US
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Telephone | 626-344-1242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.010859
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License Number State | IL
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