Provider Demographics
NPI:1679238984
Name:ERVIN FLORES, CHRISTIAN ALESSANDRO
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALESSANDRO
Last Name:ERVIN FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19634 SW 122ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4970
Mailing Address - Country:US
Mailing Address - Phone:305-680-7053
Mailing Address - Fax:
Practice Address - Street 1:19634 SW 122ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4970
Practice Address - Country:US
Practice Address - Phone:305-680-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician