Provider Demographics
NPI:1215573118
Name:FLORES, ERICKA YAJAIRA
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:YAJAIRA
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8971 MCNERNEY AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3252
Mailing Address - Country:US
Mailing Address - Phone:323-793-2897
Mailing Address - Fax:
Practice Address - Street 1:8971 MCNERNEY AVE APT C
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3252
Practice Address - Country:US
Practice Address - Phone:323-793-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4205224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant