Basic Information
Provider Information
NPI: 1881983724
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLORES
FirstName: MAHDY
MiddleName: ARTURO
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10800 MAGNOLIA AVE
Address2:  
City: RIVERSIDE
State: CA
PostalCode: 925053043
CountryCode: US
TelephoneNumber: 9513532000
FaxNumber:  
Practice Location
Address1: 10800 MAGNOLIA AVE
Address2:  
City: RIVERSIDE
State: CA
PostalCode: 925053043
CountryCode: US
TelephoneNumber: 9513532000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2011
LastUpdateDate: 11/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X20A11663CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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