Healthcare Provider Details

I. General information

NPI: 1124147285
Provider Name (Legal Business Name): MARIA ELENA FLORES P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE SUITE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

568 E HERNDON AVE SUITE 201
FRESNO CA
93720-2989
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax: 559-226-3709
Mailing address:
  • Phone: 559-228-6600
  • Fax: 559-226-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: