Healthcare Provider Details

I. General information

NPI: 1710981626
Provider Name (Legal Business Name): JAMES P. DE LA FLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE STE 210
SANTA CLARITA CA
91321-2381
US

IV. Provider business mailing address

777 FLOWER ST STE A
GLENDALE CA
91201-3000
US

V. Phone/Fax

Practice location:
  • Phone: 661-222-9381
  • Fax: 661-222-2264
Mailing address:
  • Phone: 818-637-2000
  • Fax: 818-242-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: