Provider Demographics
NPI:1003489576
Name:PIEDRA FLORES, JUAN PABLO
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:PIEDRA FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 WIGWAM PKWY UNIT 1301
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6835
Mailing Address - Country:US
Mailing Address - Phone:702-806-0627
Mailing Address - Fax:
Practice Address - Street 1:6485 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6742
Practice Address - Country:US
Practice Address - Phone:702-262-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist