Provider Demographics
NPI:1538695333
Name:FLORES, ARACELY PALAGUD
Entity Type:Individual
Prefix:
First Name:ARACELY
Middle Name:PALAGUD
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 1:6036 NEWCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-6543
Mailing Address - Country:US
Mailing Address - Phone:619-813-7558
Mailing Address - Fax:
Practice Address - Street 1:4579 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3154
Practice Address - Country:US
Practice Address - Phone:619-813-7558
Practice Address - Fax:844-335-9812
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily