Provider Demographics
NPI:1619092004
Name:FLORES, LUPE D (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:LUPE
Middle Name:D
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3404
Mailing Address - Country:US
Mailing Address - Phone:760-726-2170
Mailing Address - Fax:
Practice Address - Street 1:1234 ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3404
Practice Address - Country:US
Practice Address - Phone:760-726-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555702163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool