MEDICARE: RAPHAEL ALFONSO FLORES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1275290975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAPHAEL ALFONSO FLORES

Provider Business Mailing Address
First Line	:	16466 DENHAVEN CT
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6176
Country	:	US
Telephone Number	:	760-596-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	16466 DENHAVEN CT
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6176
Country	:	US
Telephone Number	:	760-596-2546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

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