Healthcare Provider Details

I. General information

NPI: 1730550112
Provider Name (Legal Business Name): JUAN FLORES N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 UNIVERSITY AVE
RIVERSIDE CA
92507-5202
US

IV. Provider business mailing address

1030 INTERNATIONAL BLVD
OAKLAND CA
94606-3730
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 510-238-5400
  • Fax: 510-238-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95053130
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: