Healthcare Provider Details

I. General information

NPI: 1720510688
Provider Name (Legal Business Name): ANTHONY ROBERTO FLORES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7612 SIERRA PASEO LN
LAS VEGAS NV
89128-2749
US

IV. Provider business mailing address

7612 SIERRA PASEO LN
LAS VEGAS NV
89128-2749
US

V. Phone/Fax

Practice location:
  • Phone: 702-370-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRC 1082
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: