Provider Demographics
NPI:1417421876
Name:FLORES, SAMUEL BENJAMIN (MED, BCBA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:FLORES
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11356 ACALA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4314
Mailing Address - Country:US
Mailing Address - Phone:818-923-2933
Mailing Address - Fax:
Practice Address - Street 1:11356 ACALA AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4314
Practice Address - Country:US
Practice Address - Phone:818-923-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst