Provider Demographics
NPI:1861790750
Name:FLORES, GEORGINA (DC)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 W HOLT BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3600
Mailing Address - Country:US
Mailing Address - Phone:323-359-1360
Mailing Address - Fax:909-986-6622
Practice Address - Street 1:961 W HOLT BLVD
Practice Address - Street 2:STE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3600
Practice Address - Country:US
Practice Address - Phone:323-359-1360
Practice Address - Fax:909-986-6622
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor