Provider Demographics
NPI:1124623897
Name:FLORES, JOHN PAUL (SUDCC-IV-CS #6027)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:FLORES
Suffix:
Gender:M
Credentials:SUDCC-IV-CS #6027
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N CLEMENTINE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2806
Mailing Address - Country:US
Mailing Address - Phone:619-623-1797
Mailing Address - Fax:
Practice Address - Street 1:315 N CLEMENTINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2806
Practice Address - Country:US
Practice Address - Phone:619-623-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAII054890418OtherCCAPP-CADC-II
CA6027OtherCADTP-SUDCC-IV-CS