Provider Demographics
NPI:1871010587
Name:FLORES, NATALIE MERCEDES AVILES (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MERCEDES AVILES
Last Name:FLORES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5297
Mailing Address - Country:US
Mailing Address - Phone:818-606-2925
Mailing Address - Fax:
Practice Address - Street 1:5710 MOUNTAIN VISTA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2310
Practice Address - Country:US
Practice Address - Phone:702-799-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer