Healthcare Provider Details

I. General information

NPI: 1619346145
Provider Name (Legal Business Name): ANTONIO FLORES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRAND BLVD # 640
GLENDALE CA
91203-2641
US

IV. Provider business mailing address

100 N BRAND BLVD # 640
GLENDALE CA
91203-2641
US

V. Phone/Fax

Practice location:
  • Phone: 213-434-1949
  • Fax:
Mailing address:
  • Phone: 213-434-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: