Healthcare Provider Details

I. General information

NPI: 1013693134
Provider Name (Legal Business Name): LIANNA VICTORIA MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 BISCAYNE BLVD STE 312
MIAMI FL
33181-3151
US

IV. Provider business mailing address

30 SW 1ST ST APT 3113
MIAMI FL
33130-1726
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-4151
  • Fax:
Mailing address:
  • Phone: 954-540-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ11340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: