Healthcare Provider Details

I. General information

NPI: 1235680174
Provider Name (Legal Business Name): JESSICA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2016
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD
COMPTON CA
90221-3303
US

IV. Provider business mailing address

921 E COMPTON BLVD
COMPTON CA
90221-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6800
  • Fax:
Mailing address:
  • Phone: 310-668-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW70579
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW110692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: