Healthcare Provider Details

I. General information

NPI: 1093622896
Provider Name (Legal Business Name): PAULETTE FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SAN JACINTO AVE
PERRIS CA
92571-2833
US

IV. Provider business mailing address

34319 OLIVE GROVE RD
WILDOMAR CA
92595-9127
US

V. Phone/Fax

Practice location:
  • Phone: 951-210-1750
  • Fax:
Mailing address:
  • Phone: 951-210-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: