Provider Demographics
NPI:1831926682
Name:FLORES, WYNCESS JANE R
Entity type:Individual
Prefix:MRS
First Name:WYNCESS JANE
Middle Name:R
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WYNCESS JANE
Other - Middle Name:R
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1881 MITCHELL AVE UNIT 48
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6368
Mailing Address - Country:US
Mailing Address - Phone:714-398-0241
Mailing Address - Fax:
Practice Address - Street 1:1881 MITCHELL AVE UNIT 48
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6368
Practice Address - Country:US
Practice Address - Phone:714-398-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202463514294343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)