Healthcare Provider Details

I. General information

NPI: 1245824978
Provider Name (Legal Business Name): MELINDA FLORES CORREA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E CAMELBACK RD UNIT 1104
PHOENIX AZ
85014-3690
US

IV. Provider business mailing address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

V. Phone/Fax

Practice location:
  • Phone: 480-606-2662
  • Fax:
Mailing address:
  • Phone: 602-277-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN253271
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: