Provider Demographics
NPI:1104899582
Name:FLORES, AVELINA FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:AVELINA
Middle Name:FERNANDO
Last Name:FLORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVELINA
Other - Middle Name:FERNANDO
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:411 RT9
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734
Mailing Address - Country:US
Mailing Address - Phone:609-971-1711
Mailing Address - Fax:609-971-3390
Practice Address - Street 1:411 RTE 9
Practice Address - Street 2:STE 6
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734
Practice Address - Country:US
Practice Address - Phone:609-971-1711
Practice Address - Fax:609-971-3390
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA033641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75331Medicare UPIN