Provider Demographics
NPI:1588014161
Name:MOLINA, EDWIN OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:OMAR
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:URB TERRA SENORIAL
Mailing Address - Street 2:CALLE MINORCA #20
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-455-1653
Mailing Address - Fax:
Practice Address - Street 1:STA MARIA BUILDING
Practice Address - Street 2:STE 302 CALLE FERROCARRIL 450
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0000
Practice Address - Country:US
Practice Address - Phone:877-844-6669
Practice Address - Fax:787-844-6662
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-07-14
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Provider Licenses
StateLicense IDTaxonomies
PR21740207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty