Provider Demographics
NPI:1649003401
Name:FLORES, RICKY HENRY SR
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:HENRY
Last Name:FLORES
Suffix:SR
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 1:1981 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2720
Mailing Address - Country:US
Mailing Address - Phone:209-817-6500
Mailing Address - Fax:
Practice Address - Street 1:1981 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2720
Practice Address - Country:US
Practice Address - Phone:209-817-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18738101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)