Provider Demographics
NPI:1881334217
Name:FLORES, ELISHA JUSTINE
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:JUSTINE
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 ARROW PL
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5154
Mailing Address - Country:US
Mailing Address - Phone:773-680-7478
Mailing Address - Fax:
Practice Address - Street 1:7065 INDIANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4167
Practice Address - Country:US
Practice Address - Phone:951-476-0115
Practice Address - Fax:951-476-0116
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily