Healthcare Provider Details

I. General information

NPI: 1154233120
Provider Name (Legal Business Name): LATASHA FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 CENTRAL AVE NW
ALBUQUERQUE NM
87105-1890
US

IV. Provider business mailing address

3525 4TH ST NW APT A-320
ALBUQUERQUE NM
87107-2135
US

V. Phone/Fax

Practice location:
  • Phone: 505-206-0288
  • Fax:
Mailing address:
  • Phone: 972-489-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2176
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: