Healthcare Provider Details

I. General information

NPI: 1952822652
Provider Name (Legal Business Name): YOEL JOSE CARDOSO MOLINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SW 136 AVE
PEMBROKE PINES FL
33027
US

IV. Provider business mailing address

13263 NW 8TH ST
MIAMI FL
33182-1817
US

V. Phone/Fax

Practice location:
  • Phone: 954-239-4818
  • Fax: 954-751-5044
Mailing address:
  • Phone: 786-499-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME144545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: