Provider Demographics
NPI:1902391253
Name:FLORES HERNANDEZ, KEISHLA ANAIS
Entity Type:Individual
Prefix:
First Name:KEISHLA
Middle Name:ANAIS
Last Name:FLORES HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8169 CALLE CONCORDIA SUITE 412
Mailing Address - Street 2:CONDOMINIO SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1567
Mailing Address - Country:US
Mailing Address - Phone:787-284-5884
Mailing Address - Fax:787-284-5874
Practice Address - Street 1:8169 CALLE CONCORDIA SUITE 412
Practice Address - Street 2:CONDOMINIO SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1567
Practice Address - Country:US
Practice Address - Phone:787-284-5884
Practice Address - Fax:787-284-5874
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR85988163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice