Provider Demographics
NPI:1396361242
Name:FLORES, JOSE EDUARDO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EDUARDO
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 1:7817 VINELAND AVE APT 37
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4564
Mailing Address - Country:US
Mailing Address - Phone:747-477-9546
Mailing Address - Fax:
Practice Address - Street 1:7817 VINELAND AVE APT 37
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4564
Practice Address - Country:US
Practice Address - Phone:747-477-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN687950164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse