1699767657 NPI number — REBECA FLORES MORALES MD

Table of content: REBECA FLORES MORALES MD (NPI 1699767657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699767657 NPI number — REBECA FLORES MORALES MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1699767657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438A LAWTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFFSIDE PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-214-3620
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 W AMARILLO BLVD
Provider Second Line Business Practice Location Address:
AMARILLO VA HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-937-8528
Provider Business Practice Location Address Fax Number:
940-937-8628
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10105 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4276 . This is a "FIRST MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7310131 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212376 . This is a "PREFERED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7310131 . This is a "HUMANA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1533 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83059FL . This is a "SSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PE4249 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200074 . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 064683 . This is a "LA CRUZ AZUL" identifier . This identifiers is of the category "OTHER".




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