Basic Information
| Provider Information | |||||||||
| NPI: | 1184933996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ FLORES | ||||||||
| FirstName: | EDGARDO | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1135 S SUNSET AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262835183 | ||||||||
| FaxNumber: | 6262141547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A144166 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4554906 | 01 | PR | STATE DRIVER'S LICENSE | OTHER | 12779-I | 01 | PR | STATE MEDICAL LICENSE | OTHER |