Healthcare Provider Details

I. General information

NPI: 1215341110
Provider Name (Legal Business Name): MR. ANDRES MOLINA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

24 FRENCH DRIVE
BOYLSTON MA
01505
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-4522
  • Fax:
Mailing address:
  • Phone: 508-869-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberS52886926
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: