MEDICARE: FAVIOLA NICOLE MOLINA DIAZ

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1508562372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAVIOLA NICOLE MOLINA DIAZ

Provider Business Mailing Address
First Line	:	3210 EMERALD POINTE DR APT 209B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1328
Country	:	US
Telephone Number	:	754-971-8652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 EMERALD POINTE DR APT 209B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1328
Country	:	US
Telephone Number	:	754-971-8652
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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