Provider Demographics
NPI:1821167636
Name:FLORES, ANTHONY JOHN (ASL)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:FLORES
Suffix:
Gender:M
Credentials:ASL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 STETSON ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6382
Mailing Address - Country:US
Mailing Address - Phone:505-259-8550
Mailing Address - Fax:
Practice Address - Street 1:I-40 WEST, EXIT 114
Practice Address - Street 2:BUILDING #1125
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026-4611
Practice Address - Country:US
Practice Address - Phone:505-552-6008
Practice Address - Fax:505-552-6398
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist