Provider Demographics
NPI:1427036243
Name:FLORES, LISA (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 INWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7298
Mailing Address - Country:US
Mailing Address - Phone:214-905-3000
Mailing Address - Fax:214-905-3022
Practice Address - Street 1:1966 INWOOD RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7298
Practice Address - Country:US
Practice Address - Phone:214-905-3000
Practice Address - Fax:214-905-3022
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51180231H00000X
231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100671030AMedicaid
TX84084ZOtherHMO BLUE
NMB006OtherTRIWEST
TX140730601Medicaid
NM201021525OtherPRESBYTERIAN COMMERCIAL
NM201021525Medicaid
TX80246AOtherBC/BS
OK100671030AMedicaid
TX84084ZOtherHMO BLUE
NMB006OtherTRIWEST
NM201021525Medicaid