Provider Demographics
NPI:1467043331
Name:FLORES, EMILIANO RICHMOND MALLARI
Entity Type:Individual
Prefix:
First Name:EMILIANO RICHMOND
Middle Name:MALLARI
Last Name:FLORES
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 1:9300 APHRODITE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1493
Mailing Address - Country:US
Mailing Address - Phone:907-644-1005
Mailing Address - Fax:907-644-1005
Practice Address - Street 1:9300 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1493
Practice Address - Country:US
Practice Address - Phone:907-644-1005
Practice Address - Fax:907-644-1005
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2117549310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility