Provider Demographics
NPI:1780301044
Name:FLORES, MARTHA (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:TRIAY QUIJANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 NE PROVIDENCE CT APT I103
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4657
Mailing Address - Country:US
Mailing Address - Phone:702-525-8874
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:702-525-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40147-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered