Provider Demographics
NPI:1134167422
Name:FLORES, ANTHONY SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SANTOS
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92581-1508
Mailing Address - Country:US
Mailing Address - Phone:951-658-1112
Mailing Address - Fax:951-658-7980
Practice Address - Street 1:760 W ACACIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4080
Practice Address - Country:US
Practice Address - Phone:951-658-1112
Practice Address - Fax:951-658-7980
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553360Medicaid
CAG23662Medicare UPIN
CA00A553360Medicaid