Provider Demographics
NPI:1194460014
Name:FLORES, MARTHA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIE
Last Name:FLORES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:MARIE
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4305 N MESA ST STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1124
Mailing Address - Country:US
Mailing Address - Phone:915-242-6396
Mailing Address - Fax:915-242-6461
Practice Address - Street 1:4305 N MESA ST STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1124
Practice Address - Country:US
Practice Address - Phone:915-532-2477
Practice Address - Fax:915-532-2470
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076804363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology