Basic Information
| Provider Information | |||||||||
| NPI: | 1396108999 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FLORESCA | ||||||||
| FirstName: | JON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11213 ANTONIO SANTOS WAY | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799343795 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11234 ANDERSON ST | ||||||||
| Address2: | GME OFFICE WESTERLY SUITE C | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095587814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | BP10055720 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.