Healthcare Provider Details

I. General information

NPI: 1619139771
Provider Name (Legal Business Name): NICHELLE R FLORES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7746
  • Fax: 714-834-7977
Mailing address:
  • Phone: 714-834-7746
  • Fax: 714-834-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number696085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: