Provider Demographics
NPI:1093724429
Name:FLAHERTY, LOREEN M (DPM)
Entity Type:Individual
Prefix:
First Name:LOREEN
Middle Name:M
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5731
Mailing Address - Country:US
Mailing Address - Phone:559-627-2849
Mailing Address - Fax:559-627-9772
Practice Address - Street 1:2914 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5731
Practice Address - Country:US
Practice Address - Phone:559-627-2849
Practice Address - Fax:559-627-9772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE29520213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG270YMedicare UPIN
CA000E29520Medicare PIN
T11528Medicare UPIN
CA6368270001Medicare NSC
CACA139044Medicare UPIN
CA4191960001Medicare NSC