Provider Demographics
NPI:1659513166
Name:MOLINA, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:GERARDO
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:STE M
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-961-8400
Mailing Address - Fax:954-961-8401
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:STE F
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-961-4800
Practice Address - Fax:954-961-8401
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102292207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008559100Medicaid
FLHH135ZMedicare PIN