Provider Demographics
NPI:1609627991
Name:FLORES, JOSE ALFREDO JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALFREDO
Last Name:FLORES
Suffix:JR
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 1:335 IVES ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3927
Mailing Address - Country:US
Mailing Address - Phone:708-595-9854
Mailing Address - Fax:
Practice Address - Street 1:4220 W 95TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2793
Practice Address - Country:US
Practice Address - Phone:312-949-4200
Practice Address - Fax:708-423-1899
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program