Healthcare Provider Details

I. General information

NPI: 1528779782
Provider Name (Legal Business Name): DEYAJAIRA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 AIRLINE DR STE 305A
METAIRIE LA
70003-6448
US

IV. Provider business mailing address

7809 AIRLINE DR STE 305A
METAIRIE LA
70003-6448
US

V. Phone/Fax

Practice location:
  • Phone: 504-267-1234
  • Fax:
Mailing address:
  • Phone: 504-267-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9763
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: