Healthcare Provider Details

I. General information

NPI: 1932641156
Provider Name (Legal Business Name): PETER FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 05/03/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY YOUTH ALTERNATIVES 2550 W. CLINTON BUILDING B, #128
FRESNO CA
93705
US

IV. Provider business mailing address

2550 W CLINTON AVE BUILDING B, #128
FRESNO CA
93705
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-9117
  • Fax:
Mailing address:
  • Phone: 559-225-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: