Provider Demographics
NPI:1548066566
Name:FLORES, ANA LAURA (LEP #4462)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LAURA
Last Name:FLORES
Suffix:
Gender:F
Credentials:LEP #4462
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 351
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-0351
Mailing Address - Country:US
Mailing Address - Phone:209-648-7844
Mailing Address - Fax:
Practice Address - Street 1:1533 WESTMORE CT
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4067
Practice Address - Country:US
Practice Address - Phone:209-356-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4462103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist