Provider Demographics
NPI:1053570168
Name:FLORES, ISMAEL (IDC)
Entity type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PCU MICHAEL MURPHY
Mailing Address - Street 2:3380 STURTEVANT ST SUITE 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-5042
Mailing Address - Country:US
Mailing Address - Phone:619-556-6360
Mailing Address - Fax:619-556-6360
Practice Address - Street 1:PCU MICHAEL MURPHY
Practice Address - Street 2:3380 STURTEVANT ST SUITE 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5042
Practice Address - Country:US
Practice Address - Phone:619-556-6360
Practice Address - Fax:619-556-6360
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman