Healthcare Provider Details

I. General information

NPI: 1053826198
Provider Name (Legal Business Name): DIEGO MANUEL FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 MURPHY CANYON RD STE 300
SAN DIEGO CA
92123-4301
US

IV. Provider business mailing address

4046 ARIZONA ST APT 1
SAN DIEGO CA
92104-1778
US

V. Phone/Fax

Practice location:
  • Phone: 858-268-9800
  • Fax:
Mailing address:
  • Phone: 619-356-3062
  • Fax: 619-657-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: