Healthcare Provider Details

I. General information

NPI: 1629446422
Provider Name (Legal Business Name): ADALIS CARIDAD MOLINA-BURSET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN ST SUITE M
HOLLYWOOD FL
33021-3420
US

IV. Provider business mailing address

4700 SHERIDAN ST SUITE M
HOLLYWOOD FL
33021-3420
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8400
  • Fax:
Mailing address:
  • Phone: 954-961-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAT9108952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: