Provider Demographics
NPI:1104121250
Name:FLORES-RODRIGUEZ, LAURA C
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:FLORES-RODRIGUEZ
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 1:1821 S SESAME SQ
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9288
Mailing Address - Country:US
Mailing Address - Phone:956-423-4434
Mailing Address - Fax:956-423-4443
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7150
Practice Address - Country:US
Practice Address - Phone:361-592-2223
Practice Address - Fax:361-592-1967
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRI8986207V00000X
TXR0233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392180103Medicaid
TX1L5617OtherMEDICARE
TXP02601762OtherMCRR
TX3921801Medicaid