Provider Demographics
NPI:1164867305
Name:FLORES, ALEX (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 MOTTMAN ROAD
Mailing Address - Street 2:#106
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-350-0015
Mailing Address - Fax:360-350-0019
Practice Address - Street 1:2330 MOTTMAN ROAD
Practice Address - Street 2:#106
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-350-0015
Practice Address - Fax:360-350-0019
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC6034995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist