1063786416 NPI number — JACINTO M FLORES-ALVAREZ D.C. C.C.S.P.

Table of content: JACINTO M FLORES-ALVAREZ D.C. C.C.S.P. (NPI 1063786416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063786416 NPI number — JACINTO M FLORES-ALVAREZ D.C. C.C.S.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORES-ALVAREZ
Provider First Name:
JACINTO
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C. C.C.S.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLORES
Provider Other First Name:
MIKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C. C.C.S.P.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063786416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/06/2021
NPI Reactivation Date:
03/08/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23331 VIA VENADO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO DE CAZA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15520 ROCKFIELD BLVD STE A200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-6705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-598-9999
Provider Business Practice Location Address Fax Number:
949-598-9990
Provider Enumeration Date:
03/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  32173 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com