Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | DO1486 | NV |
NPI | 1104087287 |
---|---|
Provider Name | Patrick Henry Flores |
First Address | Las Vegas, NV 89128-0436 |
Second Address | Las Vegas, NV 89128-0436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 04/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-119512 | LICENSE (01) | IL |
CS18031 | NV PHARMACY CERTIFICATE (01) | NV |
DO1486 | NV MEDICAL LICENSE (01) | NV |
FF0574384 | DEA (01) | IL |