Provider Demographics
NPI:1609478023
Name:FLORES, PETRA (MEDICAL/ SOCIAL INTE)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MEDICAL/ SOCIAL INTE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ROAD 40
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2751
Mailing Address - Country:US
Mailing Address - Phone:509-851-1705
Mailing Address - Fax:505-097-9210
Practice Address - Street 1:1208 ROAD 40
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2751
Practice Address - Country:US
Practice Address - Phone:509-851-1705
Practice Address - Fax:509-792-1030
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty