Healthcare Provider Details

I. General information

NPI: 1295591717
Provider Name (Legal Business Name): ROSA YADIRA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date: 03/19/2024
Reactivation Date: 10/17/2025

III. Provider practice location address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

IV. Provider business mailing address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

V. Phone/Fax

Practice location:
  • Phone: 562-392-5339
  • Fax: 714-780-0757
Mailing address:
  • Phone: 562-392-5339
  • Fax: 714-780-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: