MEDICARE: VIMARIE FLORES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	14024	PR
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	14024	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14024	OTHER		LICENCIA

General Provider Information

NPI Number	:	1124099296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIMARIE FLORES

Provider Business Mailing Address
First Line	:	URB MONTEHIEDRA
Second Line	:	CALLE ZORZAL 197
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	939-640-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 AVE FONT MARTELO
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00791-3249
Country	:	US
Telephone Number	:	939-640-6008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/20/2023

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Directions to “ VIMARIE FLORES ” Practice Location

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