MEDICARE: MR. MIGUEL FLORES JR. L.I.S.A.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-10564	AZ

General Provider Information

NPI Number	:	1487800850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL FLORES JR. L.I.S.A.C

Provider Business Mailing Address
First Line	:	1910 N PAINTED HILLS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1532
Country	:	US
Telephone Number	:	520-904-5431
Fax Number	:	520-207-0677

Provider Business Practice Location Address
First Line	:	1910 N PAINTED HILLS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1532
Country	:	US
Telephone Number	:	520-904-5431
Fax Number	:	520-207-0677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2008
Last Update Date	:	08/17/2008

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