Healthcare Provider Details

I. General information

NPI: 1336814987
Provider Name (Legal Business Name): AMBER DAWN FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 S FIGUEROA ST
LOS ANGELES CA
90037-2642
US

IV. Provider business mailing address

11621 VICILIA ST
GARDEN GROVE CA
92841-1945
US

V. Phone/Fax

Practice location:
  • Phone: 323-235-3535
  • Fax:
Mailing address:
  • Phone: 562-360-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: