Provider Demographics
NPI:1023202579
Name:FLORES, ELADIO DIESTO (PT)
Entity Type:Individual
Prefix:MR
First Name:ELADIO
Middle Name:DIESTO
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 YORKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6769
Mailing Address - Country:US
Mailing Address - Phone:562-303-6207
Mailing Address - Fax:
Practice Address - Street 1:2920 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5305
Practice Address - Country:US
Practice Address - Phone:562-594-8600
Practice Address - Fax:562-594-4599
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33673261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy