Healthcare Provider Details

I. General information

NPI: 1215352968
Provider Name (Legal Business Name): AMAIRANI DANAE FLORES LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

IV. Provider business mailing address

9155 PACIFIC AVE APT 240
ANAHEIM CA
92804-5860
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-8455
  • Fax:
Mailing address:
  • Phone: 714-401-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number37292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: