Healthcare Provider Details

I. General information

NPI: 1477420610
Provider Name (Legal Business Name): AYESHA MERYIAH FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 SAINT FRANCIS LN UNIT 3
TAOS NM
87571-8240
US

IV. Provider business mailing address

PO BOX 443
EL PRADO NM
87529-0443
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-2828
  • Fax:
Mailing address:
  • Phone: 575-779-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: