Provider Demographics
NPI:1710004361
Name:FLORES, MAGALY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MAGALY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FOUNTAIN PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:956-316-0445
Practice Address - Street 1:1403 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8752
Practice Address - Country:US
Practice Address - Phone:956-725-4500
Practice Address - Fax:956-725-4505
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169033101Medicaid
TX45-4849Medicare ID - Type Unspecified