Provider Demographics
NPI:1861621047
Name:FLORES, JESUS RODOLFO (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:RODOLFO
Last Name:FLORES
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LOS OLMOS
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4588
Mailing Address - Country:US
Mailing Address - Phone:956-455-5587
Mailing Address - Fax:
Practice Address - Street 1:9475 LOS OLMOS
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4588
Practice Address - Country:US
Practice Address - Phone:956-455-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163606001Medicaid