Healthcare Provider Details

I. General information

NPI: 1144317082
Provider Name (Legal Business Name): WILFREDO N. MOLANO MDSC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 MAIN ST
HURRICANE WV
25526-1420
US

IV. Provider business mailing address

PO BOX 428
HURRICANE WV
25526
US

V. Phone/Fax

Practice location:
  • Phone: 304-562-3331
  • Fax:
Mailing address:
  • Phone: 304-562-3331
  • Fax: 304-562-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number10473
License Number StateWV

VIII. Authorized Official

Name: DR. WILFREDO NAVA MOLANO
Title or Position: PHYSICIAN/ADMINISTRATOR
Credential: M.D.
Phone: 304-562-3331