Provider Demographics
NPI:1679949630
Name:FLORES ESMURRIA, RUTH ENID
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ENID
Last Name:FLORES ESMURRIA
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:HC 2 BOX 4785
Mailing Address - Street 2:BO JAGUEYES
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9799
Mailing Address - Country:US
Mailing Address - Phone:787-219-6929
Mailing Address - Fax:
Practice Address - Street 1:2604 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2107
Practice Address - Country:US
Practice Address - Phone:787-844-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7872196929OtherPHONE