Provider Demographics
NPI:1144509811
Name:FLORES, FRED (BA)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 VAN NUYS BLVD. 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-902-5315
Mailing Address - Fax:818-780-6562
Practice Address - Street 1:6842 VAN NUYS BLVD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4650
Practice Address - Country:US
Practice Address - Phone:818-902-5315
Practice Address - Fax:818-780-6562
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health