Healthcare Provider Details

I. General information

NPI: 1649033093
Provider Name (Legal Business Name): CARLOS LUIS FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STEVENSON ST
SAN FRANCISCO CA
94103-1606
US

IV. Provider business mailing address

115 10TH ST
SAN FRANCISCO CA
94103-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-2388
  • Fax: 415-374-7854
Mailing address:
  • Phone: 415-360-2388
  • Fax: 415-374-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: