Healthcare Provider Details

I. General information

NPI: 1396994604
Provider Name (Legal Business Name): EDNA IRIS FLORES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 560
LA JOLLA CA
92037-1229
US

IV. Provider business mailing address

1791 E FIR AVE
FRESNO CA
93720-3840
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-1410
  • Fax: 858-552-0929
Mailing address:
  • Phone: 559-326-1238
  • Fax: 559-326-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN0768
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number312009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: