Provider Demographics
NPI:1558935494
Name:FLORENDO, EDUARD BRYAN B
Entity Type:Individual
Prefix:MR
First Name:EDUARD BRYAN
Middle Name:B
Last Name:FLORENDO
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 1:803 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-1802
Mailing Address - Country:US
Mailing Address - Phone:949-870-2749
Mailing Address - Fax:
Practice Address - Street 1:803 ALPINE CT
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-1802
Practice Address - Country:US
Practice Address - Phone:949-870-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician