Provider Demographics
NPI:1346395647
Name:MOLINA, DORIS N (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:N
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 AVE DE DIEGO
Mailing Address - Street 2:SUITE 105 PMB-407
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6372
Mailing Address - Country:US
Mailing Address - Phone:787-754-5091
Mailing Address - Fax:787-753-1783
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:SUITE 602
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-752-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11742207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-7626Medicare ID - Type Unspecified
PRM-41646Medicare UPIN