Healthcare Provider Details

I. General information

NPI: 1194159061
Provider Name (Legal Business Name): FLUORO FLOWER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BOULEVARD
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

PO BOX 826
MANHATTAN BEACH CA
90267-0826
US

V. Phone/Fax

Practice location:
  • Phone: 310-847-9285
  • Fax:
Mailing address:
  • Phone: 310-847-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHF 76546
License Number StateCA

VIII. Authorized Official

Name: JEAN ALEJO FIORE
Title or Position: OWNER
Credential: RT
Phone: 310-847-9285