Healthcare Provider Details

I. General information

NPI: 1881656551
Provider Name (Legal Business Name): MICHAEL HENRY FLORES AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

3108 VALENCIA DR NE
ALBUQUERQUE NM
87110-2551
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-872-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1721
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: