Provider Demographics
NPI:1215380027
Name:FLORES, MARCO ANTONIO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:ANTONIO
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2603 WILLOWBROOK LN
Mailing Address - Street 2:UNIT 33
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-6013
Mailing Address - Country:US
Mailing Address - Phone:626-376-3853
Mailing Address - Fax:
Practice Address - Street 1:21507 E CLIFF DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4844
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA767401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse