Healthcare Provider Details

I. General information

NPI: 1780478099
Provider Name (Legal Business Name): ANGELA FLORES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MINOR HALL
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

200 MINOR HALL
BERKELEY CA
94720-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2020
  • Fax:
Mailing address:
  • Phone: 510-642-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36263TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: