Healthcare Provider Details

I. General information

NPI: 1942639059
Provider Name (Legal Business Name): NIMROD FLOREZ II RDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 EL MIRADOR RD
PERRIS CA
92571
US

IV. Provider business mailing address

548 EL MIRADOR RD
PERRIS CA
92571-3436
US

V. Phone/Fax

Practice location:
  • Phone: 951-321-9897
  • Fax:
Mailing address:
  • Phone: 951-321-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number43446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: