Provider Demographics
NPI:1669063665
Name:FLORES, JOSE ISRAEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ISRAEL
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 1:1138 VIA VERA CRUZ
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1379
Mailing Address - Country:US
Mailing Address - Phone:415-577-1079
Mailing Address - Fax:
Practice Address - Street 1:1138 VIA VERA CRUZ
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1379
Practice Address - Country:US
Practice Address - Phone:415-577-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist