Provider Demographics
NPI:1497452957
Name:FLORES, MARYSE GUEVARA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARYSE
Middle Name:GUEVARA
Last Name:FLORES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1433 W MERCED AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:626-960-4989
Mailing Address - Fax:626-960-5520
Practice Address - Street 1:1433 W MERCED AVE STE 114
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3402
Practice Address - Country:US
Practice Address - Phone:626-960-4989
Practice Address - Fax:626-960-5520
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA814402Medicaid