Provider Demographics
NPI:1447975164
Name:FLORES, CLARISSA MARIE (RD, LD)
Entity type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:MARIE
Last Name:FLORES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 EVERGREEN MEMORIAL PKWY APT 11108
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-1687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 CALIFORNIA ST STE 1400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-2116
Practice Address - Country:US
Practice Address - Phone:831-484-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10242823133V00000X
IA126089133V00000X
MSD-2559133V00000X
IDD-1620133V00000X
PADN008485133V00000X
LA3808133V00000X
TXDT87117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered