Provider Demographics
NPI:1265659320
Name:MIRES, DAVID B
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:MIRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3460
Mailing Address - Country:US
Mailing Address - Phone:602-467-5700
Mailing Address - Fax:602-467-5780
Practice Address - Street 1:4701 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3460
Practice Address - Country:US
Practice Address - Phone:602-467-5700
Practice Address - Fax:602-467-5780
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist