Healthcare Provider Details

I. General information

NPI: 1215841374
Provider Name (Legal Business Name): GLENDA Y FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13805 DOTY AVE APT 53
HAWTHORNE CA
90250-7523
US

IV. Provider business mailing address

13805 DOTY AVE APT 53
HAWTHORNE CA
90250-7523
US

V. Phone/Fax

Practice location:
  • Phone: 213-219-4002
  • Fax:
Mailing address:
  • Phone: 213-219-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number79681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: