Provider Demographics
NPI:1205936069
Name:MOLINA, JUAN
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOLINA
Other - Middle Name:AMBULANCE
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1452
Mailing Address - Country:US
Mailing Address - Phone:787-214-9833
Mailing Address - Fax:787-818-0429
Practice Address - Street 1:ROAD 119 KM 29 BO HOYAMALA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-1452
Practice Address - Country:US
Practice Address - Phone:787-214-9833
Practice Address - Fax:787-818-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRP14443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTC AMB 422OtherCOMISION SERVICIO PUBLICO
PRTC AMB 422OtherCOMISION SERVICIO PUBLICO