Healthcare Provider Details

I. General information

NPI: 1801401476
Provider Name (Legal Business Name): MARTIN JACOB FLORES JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BOULDER HWY STE 100
HENDERSON NV
89015-6994
US

IV. Provider business mailing address

1221 S BOULDER HWY STE 100
HENDERSON NV
89015-6994
US

V. Phone/Fax

Practice location:
  • Phone: 702-595-1518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: