Provider Demographics
NPI:1831237981
Name:FLORES, NELSON J (PHD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:J
Last Name:FLORES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6299
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-6200
Mailing Address - Country:US
Mailing Address - Phone:714-972-0040
Mailing Address - Fax:714-972-0477
Practice Address - Street 1:2107 N BROADWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2630
Practice Address - Country:US
Practice Address - Phone:714-972-0040
Practice Address - Fax:714-972-0477
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical