Provider Demographics
NPI:1386875524
Name:FLORES, JAIME ALONZO (RN BS)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:ALONZO
Last Name:FLORES
Suffix:
Gender:M
Credentials:RN BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3203
Mailing Address - Country:US
Mailing Address - Phone:361-756-1170
Mailing Address - Fax:
Practice Address - Street 1:1209 WYOMING ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3203
Practice Address - Country:US
Practice Address - Phone:361-756-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239496163W00000X
TX745771163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163W00000XNursing Service ProvidersRegistered Nurse