Provider Demographics
NPI:1831605955
Name:FLORES, FREDERICK EUGENE (RN, MSW, CDP)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:EUGENE
Last Name:FLORES
Suffix:
Gender:M
Credentials:RN, MSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 SW 318TH PL APT D
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5143
Mailing Address - Country:US
Mailing Address - Phone:206-455-0073
Mailing Address - Fax:
Practice Address - Street 1:2133 3RD AVE STE 116
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2353
Practice Address - Country:US
Practice Address - Phone:206-432-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60478808101YA0400X
104100000X, 171M00000X
WARN60900940163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60478808OtherCHEMICAL DEPENDENCY PROFESSIONAL