Provider Demographics
NPI:1033438528
Name:FROMETA MOLINA, IRALDO (FNP)
Entity Type:Individual
Prefix:
First Name:IRALDO
Middle Name:
Last Name:FROMETA MOLINA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 SW 107TH AVE APT 144W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4376
Mailing Address - Country:US
Mailing Address - Phone:786-873-1306
Mailing Address - Fax:
Practice Address - Street 1:11801 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1344
Practice Address - Country:US
Practice Address - Phone:305-220-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029566163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice