Provider Demographics
NPI:1003700030
Name:FLORES, MARIANO (HIS)
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E MCDOWELL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2608
Mailing Address - Country:US
Mailing Address - Phone:602-956-1250
Mailing Address - Fax:602-956-7466
Practice Address - Street 1:1010 E MCDOWELL RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2608
Practice Address - Country:US
Practice Address - Phone:602-956-1250
Practice Address - Fax:602-956-7466
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD5458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist