1194485979 NPI number — MARIA DE LOS ANGELES MOLINA APRN

Table of content: MARIA DE LOS ANGELES MOLINA APRN (NPI 1194485979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194485979 NPI number — MARIA DE LOS ANGELES MOLINA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLINA
Provider First Name:
MARIA
Provider Middle Name:
DE LOS ANGELES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194485979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14491 SW 22ND TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-6336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-231-8341
Provider Business Mailing Address Fax Number:
786-801-1547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 SW 72ND ST STE 356
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-703-8061
Provider Business Practice Location Address Fax Number:
786-801-1547
Provider Enumeration Date:
12/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN11016858 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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