Provider Demographics
NPI:1932685765
Name:FLORES, ELSA
Entity Type:Individual
Prefix:MRS
First Name:ELSA
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 1:1408 S BRYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-3930
Mailing Address - Country:US
Mailing Address - Phone:956-445-9110
Mailing Address - Fax:
Practice Address - Street 1:1408 S BRYAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-3930
Practice Address - Country:US
Practice Address - Phone:956-445-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528322211Medicaid
TX1669641429Medicaid
TX1952366882Medicaid