Provider Demographics
NPI:1891388948
Name:FLORES, CARMEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1019
Mailing Address - Country:US
Mailing Address - Phone:323-804-9101
Mailing Address - Fax:866-430-3071
Practice Address - Street 1:1877 W 38TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1019
Practice Address - Country:US
Practice Address - Phone:323-804-9101
Practice Address - Fax:866-430-3071
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily