Provider Demographics
NPI:1043313497
Name:FLORES LOPEZ, ANGEL ENRIQUE (RRT,PT)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:ENRIQUE
Last Name:FLORES LOPEZ
Suffix:
Gender:M
Credentials:RRT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VISTAS DE RIO GRANDE 2 CALLE TABONUCO
Mailing Address - Street 2:#449
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-672-0020
Mailing Address - Fax:
Practice Address - Street 1:VISTAS DE RIO GRANDE 2 CALLE TABONUCO
Practice Address - Street 2:#449
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-672-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1411225100000X
PR13332279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care