Healthcare Provider Details

I. General information

NPI: 1033438528
Provider Name (Legal Business Name): IRALDO FROMETA MOLINA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 NW 2ND ST
MIAMI FL
33182-1344
US

IV. Provider business mailing address

8415 SW 107TH AVE APT 144W
MIAMI FL
33173-4376
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-2330
  • Fax:
Mailing address:
  • Phone: 786-873-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number11029566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: