Healthcare Provider Details

I. General information

NPI: 1750913810
Provider Name (Legal Business Name): ALFREDO M FLORES FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N 19TH AVE STE 6
PHOENIX AZ
85015-4602
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2616
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-9191
  • Fax:
Mailing address:
  • Phone: 602-264-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number237854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: