Healthcare Provider Details

I. General information

NPI: 1922707397
Provider Name (Legal Business Name): DESDEMORA CELESTINA MOLINA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14408 SW 159TH TER
MIAMI FL
33177-6899
US

IV. Provider business mailing address

14408 SW 159TH TER
MIAMI FL
33177-6899
US

V. Phone/Fax

Practice location:
  • Phone: 772-501-1007
  • Fax:
Mailing address:
  • Phone: 772-501-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA97145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: