Healthcare Provider Details

I. General information

NPI: 1811369937
Provider Name (Legal Business Name): MR. JAIRO FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W JACKMAN ST
LANCASTER CA
93534-2531
US

IV. Provider business mailing address

506 W JACKMAN ST
LANCASTER CA
93534-2531
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2850
  • Fax: 661-726-2854
Mailing address:
  • Phone: 661-726-2850
  • Fax: 661-726-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: