Provider Demographics
NPI:1790841534
Name:MOLINA, CARMEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1963
Mailing Address - Country:US
Mailing Address - Phone:305-681-7770
Mailing Address - Fax:305-681-7968
Practice Address - Street 1:625 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1963
Practice Address - Country:US
Practice Address - Phone:305-681-7770
Practice Address - Fax:305-681-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373890600Medicaid
FL373890600Medicaid