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NPI Code Detail

MEDICARE: MR. NESTOR ISAAC FLORES LCPC

MEDICARE: MR. NESTOR ISAAC FLORES LCPC
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
1101YP2500XProfessional Counselor180009494IL

General Provider Information

NPI Number : 1669844882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NESTOR ISAAC FLORES LCPC
Provider Business Mailing Address
First Line : 2110 SCOVILLE AVE APT 4
Second Line :
City : BERWYN
State : IL
Zip : 60402-1964
Country : US
Telephone Number : 773-759-5046
Fax Number :
Provider Business Practice Location Address
First Line : 2600 RIDGELAND AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-2725
Country : US
Telephone Number : 708-317-5926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2015
Last Update Date : 10/27/2015

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