Provider Demographics
NPI:1669893426
Name:FLORES, JOSE M (MFT INTERN)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:FLORES
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N PACIFIC COAST HWY STE 200A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-7702
Mailing Address - Country:US
Mailing Address - Phone:310-316-1610
Mailing Address - Fax:310-316-4209
Practice Address - Street 1:15957 RANDALL AVE APT 29
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4465
Practice Address - Country:US
Practice Address - Phone:909-429-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 75765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist