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NPI Code Detail

MEDICARE: MARY MARLEY MOLINO RD

MEDICARE:   MARY MARLEY MOLINO  RD
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
1133V00000XRegistered Dietitian86084564TX

General Provider Information

NPI Number : 1952256752
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MARLEY MOLINO RD
Provider Business Mailing Address
First Line : 3724 JEFFERSON ST
Second Line :
City : AUSTIN
State : TX
Zip : 78731-6225
Country : US
Telephone Number : 281-753-9262
Fax Number :
Provider Business Practice Location Address
First Line : 3637 WAKEFOREST ST
Second Line :
City : HOUSTON
State : TX
Zip : 77098-5509
Country : US
Telephone Number : 281-753-9262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2026
Last Update Date : 02/27/2026

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Directions to “ MARY MARLEY MOLINO RD” Practice Location

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