Provider Demographics
NPI:1043922453
Name:FLORES, KRYSTAL CARMEN (LVN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:CARMEN
Last Name:FLORES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:CARMEN
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:335 E AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1916
Mailing Address - Country:US
Mailing Address - Phone:661-471-4055
Mailing Address - Fax:
Practice Address - Street 1:335 E AVENUE I STE 12
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1916
Practice Address - Country:US
Practice Address - Phone:661-471-4055
Practice Address - Fax:661-524-2380
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270780164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse