Provider Demographics
NPI:1598220006
Name:FLORES, JUSTIN EMMANUEL (LAC, NKT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:EMMANUEL
Last Name:FLORES
Suffix:
Gender:M
Credentials:LAC, NKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 SHINLY PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3654
Mailing Address - Country:US
Mailing Address - Phone:415-823-5313
Mailing Address - Fax:
Practice Address - Street 1:5500 GROSSMONT CENTER DR STE 167
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3080
Practice Address - Country:US
Practice Address - Phone:619-741-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist