Provider Demographics
NPI:1669968574
Name:FLORES, JESSICA (PA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-2023
Mailing Address - Country:US
Mailing Address - Phone:323-233-3100
Mailing Address - Fax:
Practice Address - Street 1:1005 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-3068
Practice Address - Country:US
Practice Address - Phone:323-233-3100
Practice Address - Fax:323-233-3124
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55720363A00000X
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant