Provider Demographics
NPI:1528056124
Name:FLORES, GUADALUPE ALEJANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:ALEJANDRA
Last Name:FLORES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GUADALUPE
Other - Middle Name:ALEJANDRA
Other - Last Name:SAMINATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:833-887-4863
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD STE 4
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6683
Practice Address - Country:US
Practice Address - Phone:956-296-3061
Practice Address - Fax:956-296-3060
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5833TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528056124Medicaid
TX6F9002OtherMEDICARE
TX144975309Medicaid
TX00915PMedicare ID - Type Unspecified