Individual
DENISSE BALTAZAR MOLINAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11220 SE STARK ST, PORTLAND, OR 97216-3379
(971) 361-8303
Mailing address
5132 SUNNYSIDE RD SE, SALEM, OR 97306-1512
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3350359
DRIVER'S LICENSE
OR
Enumeration date
11/23/2022
Last updated
08/27/2024
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