Healthcare Provider Details

I. General information

NPI: 1598899684
Provider Name (Legal Business Name): RODOLFO MOLINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W 20TH AVE STE 105
HIALEAH FL
33012-4532
US

IV. Provider business mailing address

4055 VENTURA AVE
COCONUT GROVE FL
33133-6332
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-2277
  • Fax: 305-557-2278
Mailing address:
  • Phone: 305-557-2277
  • Fax: 305-557-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME47190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: