Provider Demographics
NPI:1982442174
Name:FLORES, ALFONSO FONZIE (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:FONZIE
Last Name:FLORES
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 BLACKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2405
Mailing Address - Country:US
Mailing Address - Phone:323-377-4363
Mailing Address - Fax:
Practice Address - Street 1:2701 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2218
Practice Address - Country:US
Practice Address - Phone:626-299-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty