Provider Demographics
NPI:1639883002
Name:FLORES, MONICA RAQUEL (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RAQUEL
Last Name:FLORES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12688 CATHY ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3332
Mailing Address - Country:US
Mailing Address - Phone:818-510-2954
Mailing Address - Fax:
Practice Address - Street 1:16921 E AVENUE O STE G
Practice Address - Street 2:
Practice Address - City:LAKE LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:93591-3045
Practice Address - Country:US
Practice Address - Phone:661-225-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596125163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health