Healthcare Provider Details

I. General information

NPI: 1679465181
Provider Name (Legal Business Name): JOEL CARDENAS FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 WALNUT BLOSSOM DR APT 2
SAN JOSE CA
95123
US

IV. Provider business mailing address

5571 WALNUT BLOSSOM DR APT 2
SAN JOSE CA
95123
US

V. Phone/Fax

Practice location:
  • Phone: 408-585-8542
  • Fax:
Mailing address:
  • Phone: 408-585-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01315573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: