Provider Demographics
NPI:1477707594
Name:FLORES, GEORGE JR (LMT,AP,REV)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:LMT,AP,REV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NE 90TH ST
Mailing Address - Street 2:
Mailing Address - City:EL PORTAL
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3123
Mailing Address - Country:US
Mailing Address - Phone:305-298-1644
Mailing Address - Fax:
Practice Address - Street 1:225 NE 90TH ST
Practice Address - Street 2:
Practice Address - City:EL PORTAL
Practice Address - State:FL
Practice Address - Zip Code:33138-3123
Practice Address - Country:US
Practice Address - Phone:305-298-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
FLAP1430171100000X
RIDA00155171100000X
VA0121000504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral