Provider Demographics
NPI:1710311709
Name:FLORES, SANDRA A (BA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:FLORES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-8810
Mailing Address - Country:US
Mailing Address - Phone:425-835-7184
Mailing Address - Fax:425-349-8304
Practice Address - Street 1:4526 FEDERAL AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-835-7184
Practice Address - Fax:425-349-8304
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60409660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health