Provider Demographics
NPI:1588269161
Name:FLORES, JUAN MANUEL JR
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3222
Mailing Address - Country:US
Mailing Address - Phone:650-579-7881
Mailing Address - Fax:650-579-2640
Practice Address - Street 1:114 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3222
Practice Address - Country:US
Practice Address - Phone:650-579-7881
Practice Address - Fax:650-579-2640
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CAMPSS-BLRIPG175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other