Provider Demographics
NPI:1780925719
Name:FLORES, SALLY
Entity type:Individual
Prefix:MS
First Name:SALLY
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 1:7293 DUMOSA AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3700
Mailing Address - Country:US
Mailing Address - Phone:760-367-3290
Mailing Address - Fax:760-367-4867
Practice Address - Street 1:7293 DUMOSA AVE STE 8
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3700
Practice Address - Country:US
Practice Address - Phone:760-369-7166
Practice Address - Fax:760-369-7167
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist