Provider Demographics
NPI:1396994604
Name:FLORES, EDNA IRIS (MD)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:IRIS
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 1:1791 E FIR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3840
Mailing Address - Country:US
Mailing Address - Phone:559-326-1238
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:9850 GENESEE AVE STE 560
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1229
Practice Address - Country:US
Practice Address - Phone:858-552-1410
Practice Address - Fax:858-552-0929
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0768207R00000X
CA312009207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214754801Medicaid
TXB104158Medicare PIN
CACB216266Medicare UPIN