Provider Demographics
NPI:1043497365
Name:FLORES, SELINA LOPEZ (L V N)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:LOPEZ
Last Name:FLORES
Suffix:
Gender:F
Credentials:L V N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 YORBA DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1556
Mailing Address - Country:US
Mailing Address - Phone:909-331-5059
Mailing Address - Fax:909-620-4426
Practice Address - Street 1:1905 YORBA DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1556
Practice Address - Country:US
Practice Address - Phone:909-331-5059
Practice Address - Fax:909-620-4426
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209128164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS 012560Medicaid