Provider Demographics
NPI:1346715885
Name:MOLANO-ROMERO, ROSARIO ADRIANA (PA)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:ADRIANA
Last Name:MOLANO-ROMERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 E 2990 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3922
Mailing Address - Country:US
Mailing Address - Phone:385-414-4953
Mailing Address - Fax:
Practice Address - Street 1:1854 E 2990 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3922
Practice Address - Country:US
Practice Address - Phone:385-414-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT11431637-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program