Provider Demographics
NPI:1033453857
Name:MOLINA, VICTOR DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DANIEL
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC01 10817
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9754
Mailing Address - Country:US
Mailing Address - Phone:787-566-5893
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 10817
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9754
Practice Address - Country:US
Practice Address - Phone:787-566-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist