Provider Demographics
NPI:1609496835
Name:FLORES, JOSEPHINE LOPEZ
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:LOPEZ
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 1:108 DEREK RD
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524-3900
Mailing Address - Country:US
Mailing Address - Phone:254-661-7676
Mailing Address - Fax:
Practice Address - Street 1:108 DEREK RD
Practice Address - Street 2:
Practice Address - City:EDDY
Practice Address - State:TX
Practice Address - Zip Code:76524-3900
Practice Address - Country:US
Practice Address - Phone:254-661-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62501164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse