Provider Demographics
NPI:1477004802
Name:FLORES, JOHN ACEVES (09/11/2017)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ACEVES
Last Name:FLORES
Suffix:
Gender:M
Credentials:09/11/2017
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:ACEVES
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R1-F1109112058
Mailing Address - Street 1:656 N PARK AVE
Mailing Address - Street 2:NCADD
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768
Mailing Address - Country:US
Mailing Address - Phone:909-629-4084
Mailing Address - Fax:909-629-4086
Practice Address - Street 1:656 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3679
Practice Address - Country:US
Practice Address - Phone:909-629-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1-F1109112058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)