Provider Demographics
NPI:1821282328
Name:FLORES, HAYDEE
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
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 1:2401 PECAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6783
Mailing Address - Country:US
Mailing Address - Phone:956-630-9774
Mailing Address - Fax:956-630-9875
Practice Address - Street 1:2401 PECAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6783
Practice Address - Country:US
Practice Address - Phone:956-630-9774
Practice Address - Fax:956-630-9875
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3986130001Medicare NSC