Provider Demographics
NPI:1457503187
Name:MOLINA, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
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:HC 01 BOX 5144
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00688
Mailing Address - Country:UM
Mailing Address - Phone:787-650-8873
Mailing Address - Fax:787-880-2046
Practice Address - Street 1:CARRETERA 639 KM 6 HM0 BO SABANA HOYOS
Practice Address - Street 2:
Practice Address - City:SABANA HOYOS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00688
Practice Address - Country:UM
Practice Address - Phone:787-650-8873
Practice Address - Fax:787-880-2046
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 5523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBV834AMedicare PIN