Healthcare Provider Details

I. General information

NPI: 1619507365
Provider Name (Legal Business Name): DIEGO E. FLORES MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

IV. Provider business mailing address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9996
  • Fax:
Mailing address:
  • Phone: 661-272-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: