Provider Demographics
NPI:1073869178
Name:FLORES, IRENE CERVANA (OD)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:CERVANA
Last Name:FLORES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3231
Mailing Address - Country:US
Mailing Address - Phone:310-901-2822
Mailing Address - Fax:
Practice Address - Street 1:1640 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3231
Practice Address - Country:US
Practice Address - Phone:310-901-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist