MEDICARE: IRALDO FROMETA MOLINA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	11029566	FL

General Provider Information

NPI Number	:	1033438528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRALDO FROMETA MOLINA FNP

Provider Business Mailing Address
First Line	:	8415 SW 107TH AVE APT 144W
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-4376
Country	:	US
Telephone Number	:	786-873-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-1344
Country	:	US
Telephone Number	:	305-220-2330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	04/22/2024

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