Provider Demographics
NPI:1295404796
Name:FLORES, DAISHA MIA
Entity Type:Individual
Prefix:
First Name:DAISHA
Middle Name:MIA
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 1:7339 N 1ST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2954
Mailing Address - Country:US
Mailing Address - Phone:559-207-4929
Mailing Address - Fax:
Practice Address - Street 1:4315 E HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4326
Practice Address - Country:US
Practice Address - Phone:559-498-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician