Provider Demographics
NPI:1629930177
Name:FLETES, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:FLETES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 EL DORADO WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3410
Mailing Address - Country:US
Mailing Address - Phone:682-422-1551
Mailing Address - Fax:
Practice Address - Street 1:3425 EL DORADO WAY
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3410
Practice Address - Country:US
Practice Address - Phone:682-422-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker