Provider Demographics
NPI:1972379865
Name:MOLINA GIRALDO, SANDRA (MS, IMH 25054)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MOLINA GIRALDO
Suffix:
Gender:F
Credentials:MS, IMH 25054
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840044
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-2044
Mailing Address - Country:US
Mailing Address - Phone:856-723-4311
Mailing Address - Fax:
Practice Address - Street 1:5124 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6518
Practice Address - Country:US
Practice Address - Phone:856-723-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health