MEDICARE: CARL 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	103K00000X	Behavior Analyst
2	172A00000X	Driver

General Provider Information

NPI Number	:	1245738251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL MOLINA

Provider Business Mailing Address
First Line	:	367 E 4TH AVE APT 5
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4853
Country	:	US
Telephone Number	:	786-508-6750
Fax Number	:

Provider Business Practice Location Address
First Line	:	16110 NW 37TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6304
Country	:	US
Telephone Number	:	786-508-6750
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	09/28/2018

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Directions to “ CARL MOLINA ” Practice Location

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