Healthcare Provider Details

I. General information

NPI: 1578634747
Provider Name (Legal Business Name): MR. ROBERTO JR. S FLORES IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 FRANCES ST
SANTA BARBARA CA
93111-2821
US

IV. Provider business mailing address

6915 PHELPS RD APT 11
GOLETA CA
93117-4071
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-0033
  • Fax:
Mailing address:
  • Phone: 805-685-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: