Healthcare Provider Details

I. General information

NPI: 1285956003
Provider Name (Legal Business Name): DAVID MOLINA RIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

IV. Provider business mailing address

PO BOX 742291
ATLANTA GA
30374-2291
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-4120
  • Fax: 941-766-4123
Mailing address:
  • Phone: 941-766-4120
  • Fax: 941-766-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number268243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: