Provider Demographics
NPI:1275635633
Name:FLORES, CARLOS (PA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1139
Mailing Address - Country:US
Mailing Address - Phone:661-371-2796
Mailing Address - Fax:661-438-1746
Practice Address - Street 1:5401 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6279
Practice Address - Country:US
Practice Address - Phone:661-836-4000
Practice Address - Fax:661-847-4097
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00072073OtherMEDICARE RAILROAD
CAOPA127711Medicare PIN
CAP00072073OtherMEDICARE RAILROAD
CAOPA127713Medicare PIN