Healthcare Provider Details

I. General information

NPI: 1790769479
Provider Name (Legal Business Name): RICARDO R FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EAST CHURCH STREET BUILDING 8
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

117 W BUNNY AVE
SANTA MARIA CA
93458-2805
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3561
  • Fax: 805-739-3560
Mailing address:
  • Phone: 805-739-3561
  • Fax: 805-739-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number58554
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01077810A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: