MEDICARE: MELISSA LUCIA MOLINA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083446793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LUCIA MOLINA

Provider Business Mailing Address
First Line	:	235 EL DORADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-0805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7168
Country	:	US
Telephone Number	:	239-349-2734
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “ MELISSA LUCIA MOLINA ” Practice Location

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