Provider Demographics
NPI:1104120195
Name:FLORES, KRISTIAN ELIJAH (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:ELIJAH
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 SE SUNNYBROOK BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6777
Mailing Address - Country:US
Mailing Address - Phone:503-215-2890
Mailing Address - Fax:
Practice Address - Street 1:9290 SE SUNNYBROOK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6777
Practice Address - Country:US
Practice Address - Phone:503-215-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608175F00000X
CAA159006208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No175F00000XOther Service ProvidersNaturopath