Provider Demographics
NPI:1053878512
Name:LOUIS B FLORES MD INC - A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LOUIS B FLORES MD INC - A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-853-2220
Mailing Address - Street 1:18230 MINNEHAHA ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3428
Mailing Address - Country:US
Mailing Address - Phone:818-632-6729
Mailing Address - Fax:818-853-2221
Practice Address - Street 1:11273 LAUREL CANYON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4357
Practice Address - Country:US
Practice Address - Phone:818-853-2220
Practice Address - Fax:818-853-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32929OtherPRESIDENT'S MEDICAL LICENSE