Provider Demographics
NPI:1114742756
Name:FLORES, MELODY
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
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 1:700 AIRPORT BLVD
Mailing Address - Street 2:STE 495490
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1908
Mailing Address - Country:US
Mailing Address - Phone:650-517-8220
Mailing Address - Fax:
Practice Address - Street 1:700 AIRPORT BLVD
Practice Address - Street 2:STE 495490
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1908
Practice Address - Country:US
Practice Address - Phone:650-517-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIVERED172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker