Basic Information
| Provider Information | |||||||||
| NPI: | 1184088841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21634 RETREAT PKWY | ||||||||
| Address2: | |||||||||
| City: | TEMESCAL VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928836100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21634 RETREAT PKWY | ||||||||
| Address2: | |||||||||
| City: | TEMESCAL VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928836100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516836370 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2016 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 20A18516 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 20A18516 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | 63711 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.