Healthcare Provider Details

I. General information

NPI: 1366365389
Provider Name (Legal Business Name): YENI DRISEIDA MOLINA MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 COTTAGE ST NE STE 401
SALEM OR
97301-3861
US

IV. Provider business mailing address

528 COTTAGE ST NE STE 401
SALEM OR
97301-3861
US

V. Phone/Fax

Practice location:
  • Phone: 503-583-8537
  • Fax: 503-343-3343
Mailing address:
  • Phone: 503-583-8537
  • Fax: 503-343-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: