Provider Demographics
NPI:1407493687
Name:FLORES, VINCENT MERCED (PSS)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:MERCED
Last Name:FLORES
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 E CALLE SALAMANCA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1729
Mailing Address - Country:US
Mailing Address - Phone:520-591-4189
Mailing Address - Fax:
Practice Address - Street 1:1706 E CALLE SALAMANCA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1729
Practice Address - Country:US
Practice Address - Phone:520-591-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10586175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty