Provider Demographics
NPI:1750324141
Name:FLORES, JENNIFER PAIGE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PAIGE
Last Name:FLORES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:PAIGE
Other - Last Name:MANETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20101 SW BIRCH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1748
Mailing Address - Country:US
Mailing Address - Phone:949-721-9400
Mailing Address - Fax:949-721-9470
Practice Address - Street 1:20101 SW BIRCH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1748
Practice Address - Country:US
Practice Address - Phone:949-721-9400
Practice Address - Fax:949-721-9470
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221439OtherPTAN