Provider Demographics
NPI:1366839763
Name:FLORES, RUBEN (FL14493)
Entity type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:FL14493
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FLEMING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3308
Mailing Address - Country:US
Mailing Address - Phone:561-945-9588
Mailing Address - Fax:
Practice Address - Street 1:702 SW 28TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7923
Practice Address - Country:US
Practice Address - Phone:561-460-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL14493171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator