Healthcare Provider Details

I. General information

NPI: 1144676636
Provider Name (Legal Business Name): TEREZA MOLFINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18404 N TATUM BLVD STE 101
PHOENIX AZ
85032-1511
US

IV. Provider business mailing address

45 MOHOULI ST. HAWAII ISLAND FAMILY MEDICINE RESIDENCY
HILO HI
96720
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-1900
  • Fax: 602-485-7450
Mailing address:
  • Phone: 808-932-3186
  • Fax: 808-932-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58479
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: