Provider Demographics
NPI:1417316761
Name:FLOREZ, STEPHEN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 MERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2524
Mailing Address - Country:US
Mailing Address - Phone:626-961-6437
Mailing Address - Fax:
Practice Address - Street 1:2488 NEWPORT BLVD STE A1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5196
Practice Address - Country:US
Practice Address - Phone:949-574-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19778111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition