Provider Demographics
NPI:1104634286
Name:FLORES FLORENCIA, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:FLORES FLORENCIA
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:PO BOX 6742
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-6742
Mailing Address - Country:US
Mailing Address - Phone:505-395-0933
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 6742
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87197-6742
Practice Address - Country:US
Practice Address - Phone:505-395-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2024-0265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist