Provider Demographics
NPI:1457756454
Name:FLORES, MANOLO III (RN)
Entity Type:Individual
Prefix:
First Name:MANOLO
Middle Name:
Last Name:FLORES
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17837 1ST AVE S # 266
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1728
Mailing Address - Country:US
Mailing Address - Phone:206-354-0912
Mailing Address - Fax:
Practice Address - Street 1:17404 AMBAUM BLVD S APT 102
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-2738
Practice Address - Country:US
Practice Address - Phone:206-354-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60346573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse