Provider Demographics
NPI:1114767712
Name:FLORES, NEMESIO LIZANDRO I
Entity type:Individual
Prefix:
First Name:NEMESIO
Middle Name:LIZANDRO
Last Name:FLORES
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 93RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5864
Mailing Address - Country:US
Mailing Address - Phone:347-640-7419
Mailing Address - Fax:
Practice Address - Street 1:9109 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7995
Practice Address - Country:US
Practice Address - Phone:347-640-7419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health