Provider Demographics
NPI:1609609510
Name:FLORES, HERBERT HOWELL LORENA
Entity type:Individual
Prefix:
First Name:HERBERT HOWELL
Middle Name:LORENA
Last Name:FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 RANCHO DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6423
Mailing Address - Country:US
Mailing Address - Phone:619-731-4611
Mailing Address - Fax:
Practice Address - Street 1:740 OTAY LAKES RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6915
Practice Address - Country:US
Practice Address - Phone:619-421-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist