Provider Demographics
NPI:1609636729
Name:FLORES, MARISOL (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4593
Mailing Address - Country:US
Mailing Address - Phone:209-558-7400
Mailing Address - Fax:209-558-8315
Practice Address - Street 1:917 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4593
Practice Address - Country:US
Practice Address - Phone:209-558-7400
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator