Provider Demographics
NPI:1366778037
Name:FLORES, GLORIA MINERVA (BEI LEVEL I)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MINERVA
Last Name:FLORES
Suffix:
Gender:M
Credentials:BEI LEVEL I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 GLADIOLA
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0760
Mailing Address - Country:US
Mailing Address - Phone:956-735-3973
Mailing Address - Fax:956-424-3670
Practice Address - Street 1:1801 GLADIOLA
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0760
Practice Address - Country:US
Practice Address - Phone:956-735-3973
Practice Address - Fax:956-424-3670
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX035806990604171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035806990604OtherDARS