Provider Demographics
NPI:1528381670
Name:FLORES, RAFAEL A (MFT)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:FLORES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LOMBARDI CT STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5454
Mailing Address - Country:US
Mailing Address - Phone:707-547-2222
Mailing Address - Fax:707-547-2229
Practice Address - Street 1:751 LOMBARDI CT STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5454
Practice Address - Country:US
Practice Address - Phone:707-547-2222
Practice Address - Fax:707-547-2229
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist