Healthcare Provider Details

I. General information

NPI: 1568075976
Provider Name (Legal Business Name): MANUEL MOLINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1551C
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4873
  • Fax:
Mailing address:
  • Phone: 305-243-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME161303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: