Healthcare Provider Details

I. General information

NPI: 1861913717
Provider Name (Legal Business Name): NELLY MOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 W 37TH ST STE 404
HIALEAH FL
33012-4692
US

IV. Provider business mailing address

16061 SW 43RD TER
MIAMI FL
33185-4930
US

V. Phone/Fax

Practice location:
  • Phone: 305-960-7113
  • Fax: 305-960-7654
Mailing address:
  • Phone: 786-877-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: