1922509108 NPI number — GLADYS FLORES

Table of content: KRISTEN LEIGH LARTER APNP (NPI 1962873190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922509108 NPI number — GLADYS FLORES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLADYS FLORES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922509108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE JOSE CLEMENTE OROZCO #10122 SUITE 109
Provider Second Line Business Mailing Address:
COLONIA SONA RIO
Provider Business Mailing Address City Name:
TIJUANA
Provider Business Mailing Address State Name:
BAJA CALIFORNIA
Provider Business Mailing Address Postal Code:
22010
Provider Business Mailing Address Country Code:
MX
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE JOSE CLEMENTE OROZCO #10122 SUITE 109
Provider Second Line Business Practice Location Address:
COLONIA SONA RIO
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-488-3200
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
02/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
619-488-3200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1731204 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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