Provider Demographics
NPI:1467741231
Name:MOLINA, ROSE LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:LEONARD
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:ASB1-3-078
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-7801
Mailing Address - Fax:617-730-2833
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:ASB1-3-078
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-7801
Practice Address - Fax:617-730-2833
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262144207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty