Provider Demographics
NPI:1447745104
Name:FLOREZ, VICTORIA (PA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FLOREZ
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:
Practice Address - Street 1:3308 DEEN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-6524
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-7147
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA12073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant