Provider Demographics
NPI:1114022902
Name:MOLINA, JOAQUIN
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 TREASURE HILLS BLVD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:HARLJINGEN
Mailing Address - State:TN
Mailing Address - Zip Code:78550-8907
Mailing Address - Country:US
Mailing Address - Phone:956-366-4500
Mailing Address - Fax:956-366-4501
Practice Address - Street 1:1629 TREASURE HILLS BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:HARLJINGEN
Practice Address - State:TN
Practice Address - Zip Code:78550-8907
Practice Address - Country:US
Practice Address - Phone:956-366-4500
Practice Address - Fax:956-366-4501
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589542163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX589542OtherRN