MEDICARE: EDMUNDO L MOLINA M.D P.A

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1922303536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMUNDO L MOLINA M.D P.A

Provider Business Mailing Address
First Line	:	3260 NW 7TH ST # 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4102
Country	:	US
Telephone Number	:	305-541-6415
Fax Number	:	305-541-6655

Provider Business Practice Location Address
First Line	:	3260 NW 7TH ST # 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4102
Country	:	US
Telephone Number	:	305-541-6415
Fax Number	:	305-541-6655

Authorized Official
Title or Position	:	DOCTOR
Name	:	EDMUNDO LAZARO MOLINA
Credential	:	M.D
Telephone Number	:	305-541-6415

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/13/2011

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