Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 120975 | NY |
NPI | 1043253792 |
---|---|
Provider Name | Lucio Flores |
First Address | Brooklyn, NY 11212-3139 |
Second Address | Brooklyn, NY 11236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00424662 | (05) | NY |
A65028 | (02) | NY |