Basic Information
| Provider Information | |||||||||
| NPI: | 1437564028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | LIBERTAD | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012730641 | ||||||||
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| Practice Location | |||||||||
| Address1: | 239 CRANSTON ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029072406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014440580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | LP03081 | RI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD16289 | RI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.