Provider Demographics
NPI:1124282116
Name:FLORES, JESSE J (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:J
Last Name:FLORES
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-3150
Mailing Address - Country:US
Mailing Address - Phone:239-252-7331
Mailing Address - Fax:239-252-7301
Practice Address - Street 1:419 N 1ST ST
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-3150
Practice Address - Country:US
Practice Address - Phone:239-252-7331
Practice Address - Fax:239-252-7301
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker