Healthcare Provider Details

I. General information

NPI: 1396108999
Provider Name (Legal Business Name): JON FLORESCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST GME OFFICE WESTERLY SUITE C
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST STE MC-2605J
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-7814
  • Fax:
Mailing address:
  • Phone: 909-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA153707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10055720
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: