Provider Demographics
NPI:1659667723
Name:MOLINA, ROGELIO III
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:MOLINA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4741
Mailing Address - Country:US
Mailing Address - Phone:956-615-0047
Mailing Address - Fax:956-615-0146
Practice Address - Street 1:5502 SAN BERNARDO AVE STE 600
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3019
Practice Address - Country:US
Practice Address - Phone:956-728-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner