Provider Demographics
NPI:1508562372
Name:MOLINA DIAZ, FAVIOLA NICOLE
Entity Type:Individual
Prefix:
First Name:FAVIOLA
Middle Name:NICOLE
Last Name:MOLINA DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 EMERALD POINTE DR APT 209B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1328
Mailing Address - Country:US
Mailing Address - Phone:754-971-8652
Mailing Address - Fax:
Practice Address - Street 1:3210 EMERALD POINTE DR APT 209B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1328
Practice Address - Country:US
Practice Address - Phone:754-971-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker