Healthcare Provider Details

I. General information

NPI: 1548183858
Provider Name (Legal Business Name): MARTIN FLORES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 9TH ST
SANTA MONICA CA
90404-4501
US

IV. Provider business mailing address

720 S KERN AVE
LOS ANGELES CA
90022-2526
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax:
Mailing address:
  • Phone: 323-439-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number757839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: