Healthcare Provider Details

I. General information

NPI: 1902447865
Provider Name (Legal Business Name): ELIDA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 CHELSEA ST
RIDGECREST CA
93555-3208
US

IV. Provider business mailing address

199 E UPJOHN AVE
RIDGECREST CA
93555-4179
US

V. Phone/Fax

Practice location:
  • Phone: 760-463-2880
  • Fax:
Mailing address:
  • Phone: 661-346-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: