Healthcare Provider Details

I. General information

NPI: 1376199042
Provider Name (Legal Business Name): NANCY ANN FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 08/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 JEFFERSON ST
DELANO CA
93215-2238
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-0463
  • Fax:
Mailing address:
  • Phone: 818-206-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: