Provider Demographics
NPI:1861198756
Name:FLORES, ROLANDO (BHT)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3805
Mailing Address - Country:US
Mailing Address - Phone:520-610-3163
Mailing Address - Fax:520-777-0208
Practice Address - Street 1:75 N GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3805
Practice Address - Country:US
Practice Address - Phone:520-610-3163
Practice Address - Fax:520-777-0208
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)