Provider Demographics
NPI:1043202468
Name:MOLINA GONZALEZ, DAVID (GP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MOLINA GONZALEZ
Suffix:
Gender:M
Credentials:GP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1328
Mailing Address - Country:US
Mailing Address - Phone:787-820-4617
Mailing Address - Fax:787-820-4617
Practice Address - Street 1:4 CALLE SANTIAGO RIVERA MORELL
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2603
Practice Address - Country:US
Practice Address - Phone:787-820-4617
Practice Address - Fax:787-820-4617
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7735OtherMEDICAL LICENSE OF PR
PRBG0900426OtherFEDERAL LICENSE
PR7735OtherMEDICAL LICENSE OF PR
PRE-80037Medicare ID - Type Unspecified