Provider Demographics
NPI:1982473245
Name:FLORES, MINDY LISSETT
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LISSETT
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 1:12810 HEACOCK ST STE B202
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2873
Mailing Address - Country:US
Mailing Address - Phone:951-247-6542
Mailing Address - Fax:
Practice Address - Street 1:12810 HEACOCK ST, STE B202
Practice Address - Street 2:MORENO VALLEY
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3165
Practice Address - Country:US
Practice Address - Phone:951-247-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program