Active NPI
Daniel Flores, DO
- Student Health Clinic/Center
- Portland, OR
National Provider Identifier
1336889724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student Health Clinic/Center
- License
- 390200000X
- Practice address
- 1200 NW 23Rd Ave
Portland, OR 97210-2906 - Phone
- (503) 413-7074
- Fax
- (503) 413-6892
- NPI assigned
- Apr 1, 2022
- Last updated
- Apr 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student Health Clinic/Center | 261QS1000X | 390200000X | OR | Primary |
Addresses
Primary practice location
1200 NW 23Rd Ave
Portland, OR 97210-2906
Mailing address
705 Citra Ave
Moxee, WA 98936-8815
Phone (509) 584-8155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220620000557 | OR | Order and Referring Only - Internal Medicine | 9436538683 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 390200000X | OR | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648771200000",
"number": "1336889724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 CITRA AVE",
"city": "MOXEE",
"state": "WA",
"postal_code": "989368815",
"telephone_number": "509-584-8155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 NW 23RD AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102906",
"telephone_number": "503-413-7074",
"fax_number": "503-413-6892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLORES",
"first_name": "DANIEL",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-01",
"last_updated": "2022-04-01",
"certification_date": "2022-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "261QS1000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Student Health",
"state": "OR",
"license": "390200000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.