Provider Demographics
NPI:1043337686
Name:FLOREZ, ALEX (BRIENING INTERN)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:BRIENING INTERN
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:FLOREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BRIENING INTERN
Mailing Address - Street 1:10207 STATE HIGHWAY 33
Mailing Address - Street 2:10207 HIGHWAY 33
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9452
Mailing Address - Country:US
Mailing Address - Phone:209-894-3036
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:1904 RICLAND AVE
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-541-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)