Provider Demographics
NPI:1821712563
Name:FLORES, MANUEL JUAN
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:JUAN
Last Name:FLORES
Suffix:
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:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-0930
Mailing Address - Country:US
Mailing Address - Phone:559-908-0654
Mailing Address - Fax:
Practice Address - Street 1:2547 W SHAW AVE STE 113
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3321
Practice Address - Country:US
Practice Address - Phone:559-241-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst