Healthcare Provider Details

I. General information

NPI: 1841100419
Provider Name (Legal Business Name): MR. RAFAEL ENRIQUE FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N IMPERIAL AVE
IMPERIAL CA
92251-1267
US

IV. Provider business mailing address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 760-592-0088
  • Fax:
Mailing address:
  • Phone: 760-592-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: