Healthcare Provider Details

I. General information

NPI: 1003700030
Provider Name (Legal Business Name): MARIANO FLORES HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 200
PHOENIX AZ
85006-2608
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE 206
PHOENIX AZ
85006-2608
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-1250
  • Fax: 602-956-7466
Mailing address:
  • Phone: 602-956-1250
  • Fax: 602-956-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD5458
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: