Provider Information for 1699397372
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TANISHA FLOWERS
Sex: Female
NPI: 1699397372
Last Updated: 2024-10-15
Certification Date: 2023-11-23
Certification Date: 2023-11-23
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1699397372 | ||||||||||||||
| Enumeration Date | 2020-05-15 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1775 E 20TH ST APT C7 SAN BERNARDINO, CA 92404-5657 United States Phone: 760-961-6631 | Fax: | ||||||||||||||
| Primary Practice Address | 21101 DALE EVANS PKWY APPLE VALLEY, CA 92307-9356 United States Phone: 760-961-6631 | Fax: | ||||||||||||||
| Secondary Practice Address(es) | 1775 E 20TH ST APT C7 | ||||||||||||||
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