Provider Demographics
NPI:1689346538
Name:FLORES MEJIA, MARIO R
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:R
Last Name:FLORES MEJIA
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 1:1518 SEPIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7029
Mailing Address - Country:US
Mailing Address - Phone:303-257-2906
Mailing Address - Fax:
Practice Address - Street 1:2450 S VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:720-828-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program