Provider Demographics
NPI:1053034413
Name:FLORES, JONATHAN MIGUEL (RN BSN)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MIGUEL
Last Name:FLORES
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34711 DATE ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2715
Mailing Address - Country:US
Mailing Address - Phone:909-768-4222
Mailing Address - Fax:
Practice Address - Street 1:1214 HEATH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4919
Practice Address - Country:US
Practice Address - Phone:909-768-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95176671163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy