Provider Demographics
NPI:1932621000
Name:FLORENTINO, MARK (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FLORENTINO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2631
Mailing Address - Country:US
Mailing Address - Phone:559-635-7100
Mailing Address - Fax:559-635-7106
Practice Address - Street 1:1001 VAN DORSTEN AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2321
Practice Address - Country:US
Practice Address - Phone:559-992-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine