Provider Demographics
NPI:1134666795
Name:FLORES, SHIRLEY (BA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13905 WARHOL CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2565
Mailing Address - Country:US
Mailing Address - Phone:951-807-9311
Mailing Address - Fax:
Practice Address - Street 1:13905 WARHOL CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2565
Practice Address - Country:US
Practice Address - Phone:951-807-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician