Provider Demographics
NPI:1790957876
Name:MOLINA, LISSETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
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 1:6141 SUNSET DRIVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5026
Mailing Address - Country:US
Mailing Address - Phone:305-667-4511
Mailing Address - Fax:
Practice Address - Street 1:6141 SUNSET DRIVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5026
Practice Address - Country:US
Practice Address - Phone:305-667-4511
Practice Address - Fax:305-667-0411
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101165207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101165OtherFLORIDA LICENSE