Healthcare Provider Details

I. General information

NPI: 1679127807
Provider Name (Legal Business Name): TANAHIRY FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N MLK BLVD STE 212
NORTH LAS VEGAS NV
89032-7676
US

IV. Provider business mailing address

1517 N MOJAVE RD
LAS VEGAS NV
89101-1630
US

V. Phone/Fax

Practice location:
  • Phone: 702-644-6260
  • Fax:
Mailing address:
  • Phone: 702-807-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: