Basic Information
| Provider Information | |||||||||
| NPI: | 1083838494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 SETON CENTER PKWY | ||||||||
| Address2: | SUITE 215-CREDENTIALING | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122315548 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1807 W SLAUGHTER LN | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787486230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122828967 | ||||||||
| FaxNumber: | 5124067351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34482 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | P9566 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 341969901 | 05 | TX | MEDICAID | AZ34482 | 01 | LICENSE | OTHER | BF9497670 | 01 | DEA | OTHER | 341969902 | 05 | TX | MEDICAID |