Provider Demographics
NPI:1265740278
Name:HENRY W. FLOREZ
Entity type:Organization
Organization Name:HENRY W. FLOREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-9166
Mailing Address - Street 1:2730 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6903
Mailing Address - Country:US
Mailing Address - Phone:928-344-9166
Mailing Address - Fax:928-344-9168
Practice Address - Street 1:2730 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-9166
Practice Address - Fax:928-344-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4724261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care