Provider Demographics
NPI:1215930706
Name:FLORES-DEJESUS, GLYCED (MD)
Entity type:Individual
Prefix:DR
First Name:GLYCED
Middle Name:
Last Name:FLORES-DEJESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9369
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9369
Mailing Address - Country:US
Mailing Address - Phone:787-755-8597
Mailing Address - Fax:787-755-8597
Practice Address - Street 1:DOCTORS MEDICAL PAVILLION SUITE 20
Practice Address - Street 2:1394 CALLE SAN RAFAEL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-755-8597
Practice Address - Fax:787-755-8597
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE33465Medicare UPIN
PR83679Medicare PIN
PR0083679Medicare PIN