Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 608 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A159006 | CA |
NPI | 1104120195 |
---|---|
Provider Name | Dr. Kristian Elijah Flores |
First Address | Clackamas, OR 97015-6777 |
Second Address | Clackamas, OR 97015-6777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2011 |
Last Update Date | 15/09/2021 |