Provider Demographics
NPI:1508364670
Name:FLORES, ANTONIO JOHN MATTHEW
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOHN MATTHEW
Last Name:FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24275 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-7285
Mailing Address - Country:US
Mailing Address - Phone:951-677-5599
Mailing Address - Fax:
Practice Address - Street 1:24275 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7285
Practice Address - Country:US
Practice Address - Phone:951-677-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1952546400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor