Provider Demographics
NPI:1578152856
Name:FLORES, JUSTIN JUAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JUAN
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ESPLANADE APT 104
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4125
Mailing Address - Country:US
Mailing Address - Phone:559-474-3300
Mailing Address - Fax:
Practice Address - Street 1:600 ESPLANADE APT 104
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4125
Practice Address - Country:US
Practice Address - Phone:559-474-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant