Provider Demographics
NPI:1790915270
Name:FLORA, ZELPHA MARIE (CST)
Entity Type:Individual
Prefix:
First Name:ZELPHA
Middle Name:MARIE
Last Name:FLORA
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WEST FIRST STREET, SUITE 300, THIRD FLOOR
Mailing Address - Street 2:DAYTON VITREO-RETINAL ASSOCIATES, INC.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-3033
Mailing Address - Country:US
Mailing Address - Phone:937-228-5015
Mailing Address - Fax:937-228-5971
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-298-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCERTIFICATE#31601246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist