Provider Demographics
NPI:1336165885
Name:JACOB N FLORES
Entity Type:Organization
Organization Name:JACOB N FLORES
Other - Org Name:MOBILE MEDICINE OUTREACH MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:NAVA
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-754-5663
Mailing Address - Street 1:2171 S EL CAMINO REAL STE 104
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6269
Mailing Address - Country:US
Mailing Address - Phone:760-754-5663
Mailing Address - Fax:760-754-5440
Practice Address - Street 1:2171 S EL CAMINO REAL STE 104
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6269
Practice Address - Country:US
Practice Address - Phone:760-754-5663
Practice Address - Fax:760-754-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17256Medicare ID - Type UnspecifiedGROUP NUMBER