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General NPI Number Information
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NPI Number | 1003116286
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Entity Type | Individual
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Provider Name | LUIS MARIO MOLINA MA
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Gender | Male
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 15736 SW 50TH TER
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City | MIAMI
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State | FL
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Zip | 33185-5035
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Country | US
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Telephone | 786-294-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 15736 SW 50TH TER
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City | MIAMI
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State | FL
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Zip | 33185-5035
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Country | US
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Telephone | 786-294-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN11003688
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA51731
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11003668
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License Number State | FL
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