MEDICARE: JULIAH CLAIRA FLORES I PCA

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	372600000X	Adult Companion	2018-MSS-GEN-00087	MT
2	385H00000X	Respite Care	2018-MSS-GEN-00087	MT

General Provider Information

NPI Number	:	1376024562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAH CLAIRA FLORES I PCA

Provider Business Mailing Address
First Line	:	PO BOX 2665
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59806
Country	:	US
Telephone Number	:	406-478-6939
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 SOUTH AVE W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-6386
Country	:	US
Telephone Number	:	406-478-6939
Fax Number	:

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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