Provider Demographics
NPI:1952843641
Name:MOLINA, JESSICA
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:MOLINA
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 1:25 SOUTHERN CROSS CIR
Mailing Address - Street 2:207
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6783
Mailing Address - Country:US
Mailing Address - Phone:954-393-6894
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTHERN CROSS CIR
Practice Address - Street 2:207
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6783
Practice Address - Country:US
Practice Address - Phone:954-393-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator