Provider Demographics
NPI:1235990607
Name:FLORES, JUANA AZUCENA
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:AZUCENA
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:AZUCENA
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JUANA FLORES, COTA/L
Mailing Address - Street 1:1025 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-2311
Mailing Address - Country:US
Mailing Address - Phone:405-655-9054
Mailing Address - Fax:
Practice Address - Street 1:2401 NW 23RD ST STE 2D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2420
Practice Address - Country:US
Practice Address - Phone:405-355-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2579224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant