Provider Demographics
NPI:1265200919
Name:FLORES ONTIVEROS, REBECCA DENICE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENICE
Last Name:FLORES ONTIVEROS
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 1:1205 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-1219
Mailing Address - Country:US
Mailing Address - Phone:915-253-8041
Mailing Address - Fax:
Practice Address - Street 1:1205 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-1219
Practice Address - Country:US
Practice Address - Phone:915-253-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX023376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist