Healthcare Provider Details

I. General information

NPI: 1205543543
Provider Name (Legal Business Name): GABRIEL FLORES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W REDLANDS BLVD STE L
REDLANDS CA
92373-8032
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-0059
  • Fax: 909-335-2828
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: