Healthcare Provider Details

I. General information

NPI: 1386341600
Provider Name (Legal Business Name): MOLINAS MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EVERETT AVE STE 1A
CHELSEA MA
02150-2370
US

IV. Provider business mailing address

99 TUDOR ST
CHELSEA MA
02150-2152
US

V. Phone/Fax

Practice location:
  • Phone: 857-588-2175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL MOLINA
Title or Position: OWNER
Credential: MD
Phone: 617-466-2687