Provider Demographics
NPI:1518651736
Name:FLORES, CASSANDRA NICHOLE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICHOLE
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LUCERA CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-0911
Mailing Address - Country:US
Mailing Address - Phone:626-290-8984
Mailing Address - Fax:
Practice Address - Street 1:3185 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1367
Practice Address - Country:US
Practice Address - Phone:626-290-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician