Healthcare Provider Details

I. General information

NPI: 1528059276
Provider Name (Legal Business Name): JILL M FLORES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/04/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 25TH ST. STE 101
NATIONAL CITY CA
91950
US

IV. Provider business mailing address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3361
  • Fax: 619-827-0539
Mailing address:
  • Phone: 619-445-1188
  • Fax: 619-659-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 13473
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: