Individual provider Active NPI

Liezl Flores, DDS

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1629372669
Registry record updated May 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
60043 Issued in CA
Practice address
1233 N Vermont Ave
Suite #5
Los Angeles, CA 90029-1749
Phone
(323) 953-9471
Fax
(323) 953-9785
NPI assigned
Jan 5, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 60043 CA Primary

Addresses

Primary practice location

1233 N Vermont Ave
Suite #5
Los Angeles, CA 90029-1749

Mailing address

1233 N Vermont Ave
Suite #5
Los Angeles, CA 90029-1749
Phone (323) 953-9471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160623001484 CA Order and Referring Only - DentistPractitioner - Dentist 5698066561

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60043CAMDGeneral Practice Dentistry

Interoperability endpoints

  • Direct secure messaging: liezl.floresdds.p1@direct.jwch.nextgenshare.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431993600000",
    "number": "1629372669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 N VERMONT AVE",
            "address_2": "SUITE #5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291749",
            "telephone_number": "323-953-9471",
            "fax_number": "323-953-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 N VERMONT AVE",
            "address_2": "SUITE #5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291749",
            "telephone_number": "323-953-9471",
            "fax_number": "323-953-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORES",
        "first_name": "LIEZL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-05",
        "last_updated": "2015-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "60043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.