Provider Demographics
NPI:1659518728
Name:ROMERO, MOLLY ANN
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SISKIYOU BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2437
Mailing Address - Country:US
Mailing Address - Phone:541-482-5483
Mailing Address - Fax:
Practice Address - Street 1:3430 SE BELMONT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4247
Practice Address - Country:US
Practice Address - Phone:503-775-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist