Provider Demographics
NPI:1750306932
Name:FLORES, EDITH (MD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 WESTWOOD PLAZA
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-825-4073
Mailing Address - Fax:310-983-1172
Practice Address - Street 1:221 WESTWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-4073
Practice Address - Fax:310-983-1172
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G777850Medicaid
CA00G777850Medicaid
CAWG77785AMedicare PIN