MEDICARE: GABRIELA MOLINA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24484	FL

General Provider Information

NPI Number	:	1063952372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA MOLINA DDS

Provider Business Mailing Address
First Line	:	18503 PINES BLVD STE 208
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1405
Country	:	US
Telephone Number	:	954-499-0033
Fax Number	:	954-499-0355

Provider Business Practice Location Address
First Line	:	18503 PINES BLVD STE 208
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1405
Country	:	US
Telephone Number	:	954-499-0033
Fax Number	:	954-499-0355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	08/05/2019

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