Healthcare Provider Details

I. General information

NPI: 1164152328
Provider Name (Legal Business Name): SEBASTIAN FLOREZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE STE 346
BATON ROUGE LA
70809-3779
US

IV. Provider business mailing address

9040 EASTLAKE AVE
BATON ROUGE LA
70810-0404
US

V. Phone/Fax

Practice location:
  • Phone: 225-515-5700
  • Fax:
Mailing address:
  • Phone: 225-341-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number332592
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: