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General NPI Number Information
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NPI Number | 1003896796
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Entity Type | Individual
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Provider Name | RAFAEL EVENCIO MOLINA MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1630 13TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-3812
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Country | US
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Telephone | 304-697-2014
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1680
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City | HUNTINGTON
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State | WV
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Zip | 25717-1680
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35086645
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 21985
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License Number State | WV
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