Healthcare Provider Details

I. General information

NPI: 1801498142
Provider Name (Legal Business Name): ALEIDA JASMIN MOLINA-REZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 N FLORIDA AVE STE D-1458
TAMPA FL
33604-6007
US

IV. Provider business mailing address

1725 MERIDIAN ST
RUSKIN FL
33570-5740
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 813-310-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: