Provider Demographics
NPI:1346728763
Name:FLOREZ, EDUARDO ENRIQUE
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ENRIQUE
Last Name:FLOREZ
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 1:621 S SUN N LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-8738
Mailing Address - Country:US
Mailing Address - Phone:786-972-1073
Mailing Address - Fax:
Practice Address - Street 1:621 S SUN N LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852
Practice Address - Country:US
Practice Address - Phone:786-972-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health