Healthcare Provider Details

I. General information

NPI: 1538096144
Provider Name (Legal Business Name): TRACY FLORES-MATTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W SOUTHERN AVE STE 115-5
TEMPE AZ
85282-4500
US

IV. Provider business mailing address

1155 W GROVE PKWY APT 110
TEMPE AZ
85283-4411
US

V. Phone/Fax

Practice location:
  • Phone: 480-648-3099
  • Fax:
Mailing address:
  • Phone: 480-648-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: