Provider Demographics
NPI:1700398278
Name:FLORES, SHERYL LEOMO
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:LEOMO
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 1:1878 FARGO LN UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-4675
Mailing Address - Country:US
Mailing Address - Phone:619-316-8738
Mailing Address - Fax:
Practice Address - Street 1:1878 FARGO LN UNIT 4
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-4675
Practice Address - Country:US
Practice Address - Phone:619-316-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757482163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology