Healthcare Provider Details

I. General information

NPI: 1386556892
Provider Name (Legal Business Name): NAYELI FLORES ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 4TH ST
LA GRANDE OR
97850-2003
US

IV. Provider business mailing address

701 4TH ST
LA GRANDE OR
97850-2003
US

V. Phone/Fax

Practice location:
  • Phone: 509-520-6906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: