Provider Demographics
NPI:1972303121
Name:FLORES, ALEX JR
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:FLORES
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20690 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-5945
Mailing Address - Country:US
Mailing Address - Phone:951-575-5228
Mailing Address - Fax:
Practice Address - Street 1:20690 BROWN ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5945
Practice Address - Country:US
Practice Address - Phone:951-575-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY4409805343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)