Provider Demographics
NPI:1881960466
Name:FLORES, INA CECILIA (RD, MS, CDN)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:CECILIA
Last Name:FLORES
Suffix:
Gender:F
Credentials:RD, MS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E 10TH ST
Mailing Address - Street 2:APT 9D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6201
Mailing Address - Country:US
Mailing Address - Phone:678-749-4552
Mailing Address - Fax:
Practice Address - Street 1:28 E 10TH ST
Practice Address - Street 2:APT 9D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6201
Practice Address - Country:US
Practice Address - Phone:678-749-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered