Provider Demographics
NPI:1467711143
Name:FLORES, SORAIDA
Entity Type:Individual
Prefix:
First Name:SORAIDA
Middle Name:
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 1:15 EVERTON ST
Mailing Address - Street 2:2
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3506
Mailing Address - Country:US
Mailing Address - Phone:617-939-1352
Mailing Address - Fax:
Practice Address - Street 1:15 EVERTON
Practice Address - Street 2:2
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121
Practice Address - Country:US
Practice Address - Phone:617-939-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker