MEDICARE: FLORES AND FLORES INC A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	207Q00000X	Family Medicine Physician	A32929	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588016026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORES AND FLORES INC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	7543 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6406
Country	:	US
Telephone Number	:	323-988-5900
Fax Number	:	323-400-4238

Provider Business Practice Location Address
First Line	:	7543 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6406
Country	:	US
Telephone Number	:	323-988-5900
Fax Number	:	323-400-4238

Authorized Official
Title or Position	:	CO
Name	:	MAXIM TSELEVICH
Credential	:
Telephone Number	:	323-988-5900

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	08/12/2022

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