Provider Demographics
NPI:1639926256
Name:COLEMAN, ROMANET LEIVA FLORES
Entity type:Individual
Prefix:
First Name:ROMANET
Middle Name:LEIVA FLORES
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROMANET
Other - Middle Name:
Other - Last Name:LEIVA FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10202 SE 32ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-3611
Mailing Address - Country:US
Mailing Address - Phone:503-705-7970
Mailing Address - Fax:
Practice Address - Street 1:10202 SE 32ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3611
Practice Address - Country:US
Practice Address - Phone:503-705-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR109580172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker