Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | M001424 | GU |
NPI | 1124104195 |
---|---|
Provider Name | Lisa Denise Flores |
First Address | Tamuning, GU 96913 |
Second Address | Tamuning, GU 96913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80181 | (02) | GU |