Provider Demographics
NPI:1629000393
Name:MOLINA, RICHARD BUGARIN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BUGARIN
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 1:9921 4TH AVE
Mailing Address - Street 2:LL1-LL2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8347
Mailing Address - Country:US
Mailing Address - Phone:718-748-9282
Mailing Address - Fax:718-748-5350
Practice Address - Street 1:9921 4TH AVE
Practice Address - Street 2:LL1-LL2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8347
Practice Address - Country:US
Practice Address - Phone:718-748-9282
Practice Address - Fax:718-748-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156624207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825374Medicaid
NY00825374Medicaid
NYA60582Medicare UPIN