Provider Demographics
NPI:1891307708
Name:FLORES, ROMEO QUIAPO JR
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:QUIAPO
Last Name:FLORES
Suffix:JR
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 1:5400 KINNETT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-9588
Mailing Address - Country:US
Mailing Address - Phone:661-703-3297
Mailing Address - Fax:661-412-7061
Practice Address - Street 1:5400 KINNETT AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-9588
Practice Address - Country:US
Practice Address - Phone:661-703-3297
Practice Address - Fax:661-412-7061
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2100163056343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA84-4933008OtherPRIVATE