Healthcare Provider Details

I. General information

NPI: 1417316761
Provider Name (Legal Business Name): STEPHEN DAVID FLOREZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 NEWPORT BLVD STE A1
COSTA MESA CA
92627-5196
US

IV. Provider business mailing address

253 MERVILLE DR
BASSETT CA
91746-2524
US

V. Phone/Fax

Practice location:
  • Phone: 949-574-9311
  • Fax:
Mailing address:
  • Phone: 626-961-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number19778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: