Provider Demographics
NPI:1255448585
Name:FLORES, JOSEFINA (CRNA)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:CRNA
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 2175
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-2175
Mailing Address - Country:US
Mailing Address - Phone:909-608-2035
Mailing Address - Fax:909-608-1081
Practice Address - Street 1:11487 VIA CAPRI
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3853
Practice Address - Country:US
Practice Address - Phone:909-796-8354
Practice Address - Fax:909-796-8355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist