Healthcare Provider Details

I. General information

NPI: 1578448809
Provider Name (Legal Business Name): KIMBERLY FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

11608 206TH ST
LAKEWOOD CA
90715-1305
US

V. Phone/Fax

Practice location:
  • Phone: 562-985-4111
  • Fax:
Mailing address:
  • Phone: 562-390-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: