Healthcare Provider Details

I. General information

NPI: 1790957876
Provider Name (Legal Business Name): LISSETTE MOLINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DRIVE SUITE 401
SOUTH MIAMI FL
33143-5026
US

IV. Provider business mailing address

6141 SUNSET DRIVE SUITE 401
SOUTH MIAMI FL
33143-5026
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-4511
  • Fax: 305-667-0411
Mailing address:
  • Phone: 305-667-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME101165
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: