Provider Demographics
NPI:1609407022
Name:MOLA SANCHEZ, JAQUELINE (MMH)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:MOLA SANCHEZ
Suffix:
Gender:F
Credentials:MMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15141 SW 144TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5680
Mailing Address - Country:US
Mailing Address - Phone:786-567-0062
Mailing Address - Fax:
Practice Address - Street 1:15141 SW 144TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5680
Practice Address - Country:US
Practice Address - Phone:786-567-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFARS-805050143103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral