Provider Demographics
NPI:1376024562
Name:FLORES, JULIAH CLAIRA I (PCA)
Entity Type:Individual
Prefix:
First Name:JULIAH
Middle Name:CLAIRA
Last Name:FLORES
Suffix:I
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2665
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806
Mailing Address - Country:US
Mailing Address - Phone:406-478-6939
Mailing Address - Fax:
Practice Address - Street 1:4022 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-6386
Practice Address - Country:US
Practice Address - Phone:406-478-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2018-MSS-GEN-00087372600000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty