Healthcare Provider Details

I. General information

NPI: 1518658244
Provider Name (Legal Business Name): JESSE FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 RIVERVIEW DR
RIVERSIDE CA
92509-6611
US

IV. Provider business mailing address

12377 ROSWELL AVE
CHINO CA
91710-2050
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4175
  • Fax:
Mailing address:
  • Phone: 909-974-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: