Provider Demographics
NPI:1649688433
Name:FLORES, MAYRA (PSY M)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:PSY M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-03 BOX37298
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:787-671-9892
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 37298
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9790
Practice Address - Country:US
Practice Address - Phone:787-671-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3546103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3546OtherPSYCHOLOGY