Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY9989 | FL |
Y | 103T00000X | Psychologist | PY9989 | FL |
NPI | 1013436567 |
---|---|
Provider Name | Marcel Flores |
First Address | Molalla, OR 97038-9656 |
Second Address | Salem, OR 97301-4729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 10/12/2018 |