Basic Information
| Provider Information | |||||||||
| NPI: | 1225249014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLANO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ROSE V. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 CENTRAL CREDENTIALING | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3113 BELLEVUE AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758730 | ||||||||
| FaxNumber: | 5134758033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 35096414 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 50297 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | 35.096414 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 646182000 | 05 | MN | MEDICAID | 7100145850 | 05 | KY | MEDICAID |