Provider Demographics
NPI:1497100531
Name:FLORES, MIKE JR (LVN)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 SERENA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2847
Mailing Address - Country:US
Mailing Address - Phone:559-930-6355
Mailing Address - Fax:
Practice Address - Street 1:2061 SERENA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-2847
Practice Address - Country:US
Practice Address - Phone:559-930-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN212307164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse