Basic Information
Provider Information
NPI: 1881028579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLORES
FirstName: ANA
MiddleName: ISABEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 630 W 168TH ST # 4
Address2:  
City: NEW YORK
State: NY
PostalCode: 100323725
CountryCode: US
TelephoneNumber: 2123055098
FaxNumber: 7185794836
Practice Location
Address1: 622 W 168TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100323720
CountryCode: US
TelephoneNumber: 2123055098
FaxNumber: 7185794836
Other Information
ProviderEnumerationDate: 08/29/2013
LastUpdateDate: 09/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0002X287509NYN Allopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
282N00000X  N HospitalsGeneral Acute Care Hospital 
207R00000X35140488OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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