Provider Demographics
NPI:1811034978
Name:FLORES, GLORIA T
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:T
Last Name:FLORES
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 1:437 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2121
Mailing Address - Country:US
Mailing Address - Phone:210-436-5124
Mailing Address - Fax:210-436-5124
Practice Address - Street 1:437 OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-2121
Practice Address - Country:US
Practice Address - Phone:210-436-5124
Practice Address - Fax:210-436-5124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030088310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030088OtherRESIDENCIAL CARE