Provider Demographics
NPI:1225679715
Name:FLORES-PITOGO, MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FLORES-PITOGO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:539 W COMMERCE ST # 7971
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8325 WHITLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2493
Practice Address - Country:US
Practice Address - Phone:817-479-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00948500207Q00000X
TX1057094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine