Provider Demographics
NPI:1124196316
Name:FLORES, NIRMA IRIS (MT LIC 1894)
Entity Type:Individual
Prefix:MRS
First Name:NIRMA
Middle Name:IRIS
Last Name:FLORES
Suffix:
Gender:F
Credentials:MT LIC 1894
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-862-4230
Mailing Address - Fax:787-862-4230
Practice Address - Street 1:CALLE COMERCIO 14
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-4230
Practice Address - Fax:787-862-4230
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1894246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
40D0670594OtherCLIA #
40D0670594OtherCLIA #