Healthcare Provider Details

I. General information

NPI: 1184891434
Provider Name (Legal Business Name): LISSETTE MOLINA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5028
US

IV. Provider business mailing address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5028
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME101165
License Number StateFL

VIII. Authorized Official

Name: DR. LISSETTE MOLINA
Title or Position: PRESIDEMT
Credential: M.D.
Phone: 305-667-4511