MEDICARE: RANDY FLORES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	TG912674	OH

General Provider Information

NPI Number	:	1730889510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY FLORES

Provider Business Mailing Address
First Line	:	234 S BON AIR AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2903
Country	:	US
Telephone Number	:	330-301-7065
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 S BON AIR AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2903
Country	:	US
Telephone Number	:	330-301-7065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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Directions to “ RANDY FLORES ” Practice Location

Language	Start Address	Practice Location

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