Healthcare Provider Details

I. General information

NPI: 1104634286
Provider Name (Legal Business Name): SOFIA FLORES FLORENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6742
ALBUQUERQUE NM
87197-6742
US

IV. Provider business mailing address

PO BOX 6742
ALBUQUERQUE NM
87197-6742
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-0933
  • Fax:
Mailing address:
  • Phone: 505-395-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0265
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: