Individual
RANDY DANIEL FLORES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
188 W IVEY RD, HUACHUCA CITY, AZ 85616-8227
(520) 456-1416
Mailing address
188 W IVEY RD, HUACHUCA CITY, AZ 85616-8227
(520) 456-1416
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114178
—
AZ
Enumeration date
11/27/2006
Last updated
07/26/2007
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