Provider Demographics
NPI:1639932833
Name:FLORES, SHANTAL NOEL (AMFT)
Entity Type:Individual
Prefix:
First Name:SHANTAL
Middle Name:NOEL
Last Name:FLORES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4648
Mailing Address - Country:US
Mailing Address - Phone:480-309-8770
Mailing Address - Fax:
Practice Address - Street 1:3655 NOBEL DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1005
Practice Address - Country:US
Practice Address - Phone:858-325-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT143606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist