Provider Demographics
NPI:1417084807
Name:FLORES, JOHN R I (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:FLORES
Suffix:I
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 E 13TH ST
Mailing Address - Street 2:PO BOX 839
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-6214
Mailing Address - Country:US
Mailing Address - Phone:209-381-6800
Mailing Address - Fax:209-725-3811
Practice Address - Street 1:480 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-6214
Practice Address - Country:US
Practice Address - Phone:209-381-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 115211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW 11521OtherASSOCIATE SW