Healthcare Provider Details

I. General information

NPI: 1841441367
Provider Name (Legal Business Name): MARCOS MOLINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14109 SW 167TH TER
MIAMI FL
33177-2094
US

IV. Provider business mailing address

14109 SW 167TH TER
MIAMI FL
33177-2094
US

V. Phone/Fax

Practice location:
  • Phone: 786-486-9365
  • Fax: 305-938-0755
Mailing address:
  • Phone: 786-486-9365
  • Fax: 305-938-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberAL11192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: