Provider Demographics
NPI:1851343073
Name:FLORES, ARIEL JUSTIN (PT)
Entity Type:Individual
Prefix:MR
First Name:ARIEL JUSTIN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970277
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0277
Mailing Address - Country:US
Mailing Address - Phone:808-391-7678
Mailing Address - Fax:808-206-1278
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3031
Practice Address - Country:US
Practice Address - Phone:808-391-7678
Practice Address - Fax:808-678-2655
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1892225100000X
FL11633225100000X
CA25855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI494823Medicaid
HI55796Medicare ID - Type Unspecified