=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154917896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YANISLEIBIS MOLINA GONZALEZ FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2020
-----------------------------------------------------
Last Update Date | 01/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3810 FRY RD STE 118
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-6919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-321-4233
-----------------------------------------------------
Fax | 832-321-4310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3026 COACHMAKER TRL
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77471-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-879-3466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1107938
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------