Provider Demographics
NPI:1194159061
Name:FLUORO FLOWER CORP
Entity type:Organization
Organization Name:FLUORO FLOWER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ALEJO
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:310-847-9285
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0826
Mailing Address - Country:US
Mailing Address - Phone:310-847-9285
Mailing Address - Fax:
Practice Address - Street 1:8670 WILSHIRE BOULEVARD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-847-9285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF 76546247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty