Provider Demographics
NPI:1063786416
Name:FLORES-ALVAREZ, JACINTO M (DC CCSP)
Entity type:Individual
Prefix:
First Name:JACINTO
Middle Name:M
Last Name:FLORES-ALVAREZ
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC CCSP
Mailing Address - Street 1:23331 VIA VENADO
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15520 ROCKFIELD BLVD STE A200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-6705
Practice Address - Country:US
Practice Address - Phone:949-598-9999
Practice Address - Fax:949-598-9990
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2021-03-08
Deactivation Date:2021-01-06
Deactivation Code:
Reactivation Date:2021-03-08
Provider Licenses
StateLicense IDTaxonomies
CA32173111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician