Provider Demographics
NPI:1467987719
Name:FLORES, CRYSTAL MARDIN (MS RD LDN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MARDIN
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARDIN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:PO BOX 220224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0224
Mailing Address - Country:US
Mailing Address - Phone:907-727-8613
Mailing Address - Fax:585-302-2717
Practice Address - Street 1:241 N C ST STE 1F
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1665
Practice Address - Country:US
Practice Address - Phone:907-727-8613
Practice Address - Fax:585-302-2717
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008971-1133V00000X
AK199721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered