Provider Demographics
NPI:1861012445
Name:FLORES, EMERSON
Entity Type:Individual
Prefix:MR
First Name:EMERSON
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1418
Mailing Address - Country:US
Mailing Address - Phone:415-256-9995
Mailing Address - Fax:415-256-9998
Practice Address - Street 1:1109 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:415-256-9995
Practice Address - Fax:415-256-9998
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor