Provider Demographics
NPI:1356081970
Name:FLORES HERNANDEZ, YESSICA BELEN
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:BELEN
Last Name:FLORES HERNANDEZ
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 1:7310 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6213
Mailing Address - Country:US
Mailing Address - Phone:408-843-8519
Mailing Address - Fax:
Practice Address - Street 1:7310 MAPLE ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6213
Practice Address - Country:US
Practice Address - Phone:408-843-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3678085171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator