Healthcare Provider Details

I. General information

NPI: 1750055380
Provider Name (Legal Business Name): MRS. ANA COLOMBIA MUNOZ ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 SE 12TH ST
GRESHAM OR
97080-9132
US

IV. Provider business mailing address

2633 SE 145TH AVE
PORTLAND OR
97236-2663
US

V. Phone/Fax

Practice location:
  • Phone: 971-276-2213
  • Fax:
Mailing address:
  • Phone: 949-412-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number201709322RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: