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General NPI Number Information
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NPI Number | 1790109643
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Entity Type | Individual
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Provider Name | RICHARD JOSE MOLINA
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Gender | Male
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 633 UMATILLA BLVD
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City | UMATILLA
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State | FL
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Zip | 32784-8418
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Country | US
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Telephone | 352-669-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1559 WARRINGTON ST
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6124
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | IMH9660
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License Number State |
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