Provider Demographics
NPI:1265481410
Name:FLORES, JOSE MENDOZA JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MENDOZA
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BENEDICTA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2089
Mailing Address - Country:US
Mailing Address - Phone:719-846-2206
Mailing Address - Fax:719-846-7823
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:STE A
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2089
Practice Address - Country:US
Practice Address - Phone:719-846-2206
Practice Address - Fax:719-846-7823
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics