MEDICARE: GENE P FLORES MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT29828	CA

General Provider Information

NPI Number	:	1548494164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE P FLORES MPT

Provider Business Mailing Address
First Line	:	25115 AVENUE STANFORD STE B135
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	661-250-9940
Fax Number	:	661-250-9959

Provider Business Practice Location Address
First Line	:	3753 E THOUSAND OAKS BLVD
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3607
Country	:	US
Telephone Number	:	805-497-7900
Fax Number	:	805-497-0720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	08/24/2021

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