Provider Demographics
NPI:1295404796
Name:FLORES-LUCIO, DAISHA MIA
Entity type:Individual
Prefix:
First Name:DAISHA
Middle Name:MIA
Last Name:FLORES-LUCIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 ENTERPRISE DR APT 302
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 BLUE STREAM WAY APT 5101
Practice Address - Street 2:
Practice Address - City:INLET BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-8621
Practice Address - Country:US
Practice Address - Phone:850-896-3873
Practice Address - Fax:855-508-6637
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician