Provider Demographics
NPI:1487800850
Name:FLORES, MIGUEL JR (LISAC)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N PAINTED HILLS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1532
Mailing Address - Country:US
Mailing Address - Phone:520-904-5431
Mailing Address - Fax:520-207-0677
Practice Address - Street 1:1910 N PAINTED HILLS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1532
Practice Address - Country:US
Practice Address - Phone:520-904-5431
Practice Address - Fax:520-207-0677
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10564101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)