Provider Demographics
NPI:1215318308
Name:FLORES, KELLEY ANNE
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANNE
Last Name:FLORES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:TENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 W METROPOLITAN DR # 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3504
Mailing Address - Country:US
Mailing Address - Phone:714-972-3700
Mailing Address - Fax:
Practice Address - Street 1:4000 W METROPOLITAN DR # 120
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator