Healthcare Provider Details

I. General information

NPI: 1871409441
Provider Name (Legal Business Name): JOSE TRINIDAD FLORES RAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

831 E ARROW HWY
POMONA CA
91767-2535
US

V. Phone/Fax

Practice location:
  • Phone: 909-398-4383
  • Fax: 909-623-3101
Mailing address:
  • Phone: 909-398-4383
  • Fax: 909-623-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: