Provider Demographics
NPI:1992681530
Name:FLORES, TINA L (CADC LL)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:FLORES
Suffix:
Gender:F
Credentials:CADC LL
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:GAGNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC LL
Mailing Address - Street 1:7023 BATAVIA WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1009
Mailing Address - Country:US
Mailing Address - Phone:951-966-7706
Mailing Address - Fax:
Practice Address - Street 1:7023 BATAVIA WAY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-1009
Practice Address - Country:US
Practice Address - Phone:951-966-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065680225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty