Provider Demographics
NPI:1083912794
Name:FLOREZ, ISAAC E (PSYD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:E
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 S COLORADO BLVD
Mailing Address - Street 2:SUITE S-109
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 309
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-261-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY3758103G00000X
WAPY60060442103TC0700X
COPSY.0003758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO281504YRDZMedicare PIN
CO281504YRDZMedicare PIN