MEDICARE: DR. EMMA I MOLINA PSY.D

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	103TC0700X	Clinical Psychologist	3908	PR

General Provider Information

NPI Number	:	1548567944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMA I MOLINA PSY.D

Provider Business Mailing Address
First Line	:	PO BOX 140744
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-0744
Country	:	US
Telephone Number	:	787-640-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	X1 CALLE 15
Second Line	:	VILLA LOS SANTOS
City	:	ARECIBO
State	:	PR
Zip	:	00612-3114
Country	:	US
Telephone Number	:	787-640-6866
Fax Number	:

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	02/21/2011

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