Provider Demographics
NPI:1790085439
Name:FLORES, SOLEDAD (NP)
Entity Type:Individual
Prefix:
First Name:SOLEDAD
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4615 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2702
Mailing Address - Country:US
Mailing Address - Phone:915-532-2202
Mailing Address - Fax:
Practice Address - Street 1:4615 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2702
Practice Address - Country:US
Practice Address - Phone:915-532-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223909364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health