Provider Demographics
NPI:1932303039
Name:FLORES-GOLDBERG, NENY IVONNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NENY
Middle Name:IVONNE
Last Name:FLORES-GOLDBERG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 WOODMAR LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6516
Mailing Address - Country:US
Mailing Address - Phone:505-306-1532
Mailing Address - Fax:505-821-3398
Practice Address - Street 1:11501 WOODMAR LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6516
Practice Address - Country:US
Practice Address - Phone:505-306-1532
Practice Address - Fax:505-821-3398
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12507202Medicaid