Healthcare Provider Details

I. General information

NPI: 1336340728
Provider Name (Legal Business Name): MS. FREDDY MOLINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 687 PARCELA 136 BO SABANA SECA SABANA SECA
TOA BAJA PR
00952
US

IV. Provider business mailing address

PO BOX 1404 SABANA SECA
TOA BAJA PR
00952
US

V. Phone/Fax

Practice location:
  • Phone: 787-479-3763
  • Fax:
Mailing address:
  • Phone: 787-479-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5540
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: