Provider Demographics
NPI:1598385197
Name:FLORES, NELSON LOUIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:LOUIS
Last Name:FLORES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 N BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2625
Mailing Address - Country:US
Mailing Address - Phone:714-972-0040
Mailing Address - Fax:
Practice Address - Street 1:2107 N BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2625
Practice Address - Country:US
Practice Address - Phone:714-972-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical