Provider Demographics
NPI:1306369723
Name:FLORES, MATTHEW JOSE
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSE
Last Name:FLORES
Suffix:
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 1:6142 KARIANNE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6267
Mailing Address - Country:US
Mailing Address - Phone:909-631-0274
Mailing Address - Fax:
Practice Address - Street 1:2230 MARQUETTE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6426
Practice Address - Country:US
Practice Address - Phone:909-631-0274
Practice Address - Fax:909-631-0274
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty