Provider Demographics
NPI:1699464966
Name:FLORES, DESTINY ALEXIS
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ALEXIS
Last Name:FLORES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32395 CLINTON KEITH RD STE B12
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7568
Mailing Address - Country:US
Mailing Address - Phone:951-200-5532
Mailing Address - Fax:
Practice Address - Street 1:3877 12TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3578
Practice Address - Country:US
Practice Address - Phone:951-455-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician