Provider Demographics
NPI:1821299959
Name:MOLLEDA, BETSABE
Entity Type:Individual
Prefix:
First Name:BETSABE
Middle Name:
Last Name:MOLLEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11231 HUCKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-8957
Mailing Address - Country:US
Mailing Address - Phone:734-223-1778
Mailing Address - Fax:
Practice Address - Street 1:11231 HUCKLEBERRY LN
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-8957
Practice Address - Country:US
Practice Address - Phone:734-223-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist