Provider Demographics
NPI:1255911459
Name:FLORES, CONSUELO ALEJANDRA
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:ALEJANDRA
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 1:1237 BEL AIR DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2322
Mailing Address - Country:US
Mailing Address - Phone:209-769-2884
Mailing Address - Fax:
Practice Address - Street 1:2809 WOODBRIDGE CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3460
Practice Address - Country:US
Practice Address - Phone:209-523-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator