Healthcare Provider Details

I. General information

NPI: 1497820732
Provider Name (Legal Business Name): LOURDES FLORES SISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E SAN ANTONIO DR
LONG BEACH CA
90807-2211
US

IV. Provider business mailing address

5330 BRAE BURN PL
BUENA PARK CA
90621-1515
US

V. Phone/Fax

Practice location:
  • Phone: 562-728-9572
  • Fax: 562-728-9562
Mailing address:
  • Phone: 562-480-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA053598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: