Provider Demographics
NPI:1376840744
Name:FLORES, LUZ ELENA (MFT)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:ELENA
Last Name:FLORES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 W SUNSET BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3262
Mailing Address - Country:US
Mailing Address - Phone:213-347-4740
Mailing Address - Fax:818-476-7206
Practice Address - Street 1:1910 W SUNSET BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3262
Practice Address - Country:US
Practice Address - Phone:213-347-4740
Practice Address - Fax:818-476-7206
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT81229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL