Healthcare Provider Details

I. General information

NPI: 1801925037
Provider Name (Legal Business Name): MS. BERENICE FLYNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 RUBY ST
IMPERIAL CA
92251-2503
US

IV. Provider business mailing address

313 S WATERMAN AVE
EL CENTRO CA
92243-2215
US

V. Phone/Fax

Practice location:
  • Phone: 760-791-1335
  • Fax:
Mailing address:
  • Phone: 442-265-7353
  • Fax: 442-265-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: