Healthcare Provider Details

I. General information

NPI: 1366147266
Provider Name (Legal Business Name): LESLIE MICHELLE FLORES OTERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WATSON BLVD
WARNER ROBINS GA
31093-3431
US

IV. Provider business mailing address

2006 KARL DR APT 2202
WARNER ROBINS GA
31088-9431
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-4281
  • Fax:
Mailing address:
  • Phone: 787-393-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number111851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: