Provider Demographics
NPI:1235218488
Name:JACK H FLORIN MD INC
Entity Type:Organization
Organization Name:JACK H FLORIN MD INC
Other - Org Name:FULLERTON NEUROLOGY AND HEADACHE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-738-0800
Mailing Address - Street 1:100 LAGUNA RD
Mailing Address - Street 2:#208
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3633
Mailing Address - Country:US
Mailing Address - Phone:714-738-0800
Mailing Address - Fax:714-738-3758
Practice Address - Street 1:100 LAGUNA RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3633
Practice Address - Country:US
Practice Address - Phone:714-738-0800
Practice Address - Fax:714-738-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG265612084N0400X
CAPA145932084N0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty