Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD423719 | PA |
NPI | 1003042714 |
---|---|
Provider Name | Dr. Maria I Flores |
First Address | Philadelphia, PA 19130-2908 |
Second Address | Philadelphia, PA 19133-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 30/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102376885 - 0022 | (05) | PA |