Healthcare Provider Details

I. General information

NPI: 1831402742
Provider Name (Legal Business Name): KRISTOFFER FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MONTECITO AVE
MOUNTAIN VIEW CA
94043-4590
US

IV. Provider business mailing address

1400 MONTECITO AVE
MOUNTAIN VIEW CA
94043-4590
US

V. Phone/Fax

Practice location:
  • Phone: 408-564-3350
  • Fax:
Mailing address:
  • Phone: 805-388-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105357
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFTI66229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: