Healthcare Provider Details

I. General information

NPI: 1396457750
Provider Name (Legal Business Name): BERNARDO FLORES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLVD LAZARO CARDENAS 510 STE 64
TIJUANA BC
22115
MX

IV. Provider business mailing address

4275 EXECUTIVE SQ STE 302
LA JOLLA CA
92037-9123
US

V. Phone/Fax

Practice location:
  • Phone: 619-488-3200
  • Fax: 619-908-1095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BERNARDO FLORES
Title or Position: OPTOMETRIST
Credential: OPTOMETRIST
Phone: 619-488-3200