Healthcare Provider Details

I. General information

NPI: 1255461141
Provider Name (Legal Business Name): FELIPE JULIAN FLORES III MSW, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 CHANEY ST
LAKE ELSINORE CA
92530-2712
US

IV. Provider business mailing address

545 CHANEY ST
LAKE ELSINORE CA
92530-2712
US

V. Phone/Fax

Practice location:
  • Phone: 951-609-8450
  • Fax:
Mailing address:
  • Phone: 951-609-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number135661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: