Provider Demographics
NPI:1598899684
Name:MOLINA, RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6332
Mailing Address - Country:US
Mailing Address - Phone:305-557-2277
Mailing Address - Fax:305-557-2278
Practice Address - Street 1:3805 W 20TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4532
Practice Address - Country:US
Practice Address - Phone:305-557-2277
Practice Address - Fax:305-557-2278
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65964Medicare UPIN