Provider Demographics
NPI:1528199817
Name:FLORES CANCEL, AWILDA (MD)
Entity Type:Individual
Prefix:MISS
First Name:AWILDA
Middle Name:
Last Name:FLORES CANCEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:AWILDA
Other - Middle Name:FLORES
Other - Last Name:CANCEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:43 SANTA ROSA
Mailing Address - Street 2:BOX 316
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-0713
Mailing Address - Fax:
Practice Address - Street 1:43 SANTA ROSA
Practice Address - Street 2:BOX 316
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics