Provider Demographics
NPI:1669276341
Name:FLOREZ, JORGE A
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:FLOREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 75TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4524
Mailing Address - Country:US
Mailing Address - Phone:425-750-5803
Mailing Address - Fax:
Practice Address - Street 1:16820 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5905
Practice Address - Country:US
Practice Address - Phone:425-750-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA649300311ZA0620X
WA520702311ZA0620X
WA435600311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home