Provider Demographics
NPI:1538300439
Name:FLORES, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 HAMILTON WOLFE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3456
Mailing Address - Country:US
Mailing Address - Phone:210-616-0283
Mailing Address - Fax:210-616-0071
Practice Address - Street 1:4775 HAMILTON WOLFE RD STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3456
Practice Address - Country:US
Practice Address - Phone:210-616-0283
Practice Address - Fax:210-616-0071
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50600237700000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200902901Medicaid