Provider Demographics
NPI:1942719554
Name:FLORES, YETSANIA (COTA)
Entity Type:Individual
Prefix:
First Name:YETSANIA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 NE 6TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4089
Mailing Address - Country:US
Mailing Address - Phone:786-266-4158
Mailing Address - Fax:
Practice Address - Street 1:475 29TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3510
Practice Address - Country:US
Practice Address - Phone:510-832-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3676224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant