Provider Demographics
NPI:1578981767
Name:FLORES, BRANDI (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2212 ESMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-2597
Mailing Address - Country:US
Mailing Address - Phone:510-334-2412
Mailing Address - Fax:
Practice Address - Street 1:2212 ESMOND AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-2597
Practice Address - Country:US
Practice Address - Phone:510-334-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2021-08-20
Deactivation Date:2021-07-23
Deactivation Code:
Reactivation Date:2021-08-20
Provider Licenses
StateLicense IDTaxonomies
CAL-304091174N00000X
CA272144164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164X00000XNursing Service ProvidersLicensed Vocational Nurse