Provider Demographics
NPI:1205586096
Name:MOLETA, STEFAN LLANES (RN)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:LLANES
Last Name:MOLETA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 RHINELANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1849
Mailing Address - Country:US
Mailing Address - Phone:917-769-7692
Mailing Address - Fax:
Practice Address - Street 1:102 RIVERS EDGE RD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1163
Practice Address - Country:US
Practice Address - Phone:646-672-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29868163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health