MEDICARE: MR. JOSE MIGUEL MOLINA

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1679436372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE MIGUEL MOLINA

Provider Business Mailing Address
First Line	:	330 WALNUT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-4604
Country	:	US
Telephone Number	:	954-444-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 WALNUT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-4604
Country	:	US
Telephone Number	:	954-697-1572
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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