Provider Demographics
NPI:1619733912
Name:MOLINA, EZRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CONGRESSIONAL LN APT 301
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1535
Mailing Address - Country:US
Mailing Address - Phone:301-500-9490
Mailing Address - Fax:
Practice Address - Street 1:257 CONGRESSIONAL LN APT 301
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1535
Practice Address - Country:US
Practice Address - Phone:301-500-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR249908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health