Provider Demographics
NPI:1740019074
Name:FLORES, SANDRA TISCARENO
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:TISCARENO
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 1:612 CROW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2182
Mailing Address - Country:US
Mailing Address - Phone:209-712-1620
Mailing Address - Fax:
Practice Address - Street 1:9275 GLACIER POINT DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3494
Practice Address - Country:US
Practice Address - Phone:209-953-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool