Healthcare Provider Details

I. General information

NPI: 1659990687
Provider Name (Legal Business Name): LAURA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date: 06/12/2023
Reactivation Date: 08/11/2025

III. Provider practice location address

1020 S ARROYO PKWY
PASADENA CA
91105-3911
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-2794
  • Fax: --
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: