Healthcare Provider Details

I. General information

NPI: 1619417342
Provider Name (Legal Business Name): ANTHONY FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 BEACH BLVD SUITE #155
WESTMINSTER CA
92683-4453
US

IV. Provider business mailing address

14140 BEACH BLVD SUITE #155
WESTMINSTER CA
92683-4453
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-7556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCCI 2805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: