Provider Demographics
NPI:1538811765
Name:FLORES, LYDIA VICTORIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:VICTORIA
Last Name:FLORES
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 1:7 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1320
Mailing Address - Country:US
Mailing Address - Phone:304-395-7710
Mailing Address - Fax:
Practice Address - Street 1:7 MILLER LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1320
Practice Address - Country:US
Practice Address - Phone:304-395-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program