Healthcare Provider Details

I. General information

NPI: 1043848807
Provider Name (Legal Business Name): ERNEST FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 12/22/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 3RD AVE STE 101
CHULA VISTA CA
91911-1349
US

IV. Provider business mailing address

865 3RD AVE STE 101
CHULA VISTA CA
91911-1349
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-7910
  • Fax:
Mailing address:
  • Phone: 619-426-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number88743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: