Provider Demographics
NPI:1497437107
Name:FLORES, LENIN (CHW)
Entity Type:Individual
Prefix:
First Name:LENIN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SW BARNES RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6670
Mailing Address - Country:US
Mailing Address - Phone:503-454-7121
Mailing Address - Fax:503-535-6351
Practice Address - Street 1:9555 SW BARNES RD STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6670
Practice Address - Country:US
Practice Address - Phone:503-454-7121
Practice Address - Fax:503-535-6351
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109413172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker