Healthcare Provider Details

I. General information

NPI: 1376024562
Provider Name (Legal Business Name): JULIAH CLAIRA FLORES I PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 SOUTH AVE W
MISSOULA MT
59804-6386
US

IV. Provider business mailing address

PO BOX 2665
MISSOULA MT
59806
US

V. Phone/Fax

Practice location:
  • Phone: 406-478-6939
  • Fax:
Mailing address:
  • Phone: 406-478-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number2018-MSS-GEN-00087
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number2018-MSS-GEN-00087
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: