Provider Demographics
NPI:1376803270
Name:FLORES, LEODEGARIO CORTEZ JR (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:LEODEGARIO
Middle Name:CORTEZ
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 WILLOW PASS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5223
Mailing Address - Country:US
Mailing Address - Phone:925-646-5480
Mailing Address - Fax:925-646-5622
Practice Address - Street 1:1420 WILLOW PASS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5223
Practice Address - Country:US
Practice Address - Phone:925-646-5480
Practice Address - Fax:925-646-5622
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA631723163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse