Healthcare Provider Details

I. General information

NPI: 1184565608
Provider Name (Legal Business Name): FLORESITA PUTH LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 PERALTA BLVD STE 108
FREMONT CA
94536-3959
US

IV. Provider business mailing address

34159 FREMONT BLVD # 2019
FREMONT CA
94555-2230
US

V. Phone/Fax

Practice location:
  • Phone: 341-233-4851
  • Fax:
Mailing address:
  • Phone: 341-233-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL10124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: