Provider Demographics
NPI:1245906205
Name:MOLINA MARQUEZ, GABRIELA ANDREA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ANDREA
Last Name:MOLINA MARQUEZ
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 1:520 SE 23RD LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5789
Mailing Address - Country:US
Mailing Address - Phone:910-685-4365
Mailing Address - Fax:
Practice Address - Street 1:13650 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6277
Practice Address - Country:US
Practice Address - Phone:954-289-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2022-08-11
Deactivation Date:2021-08-21
Deactivation Code:
Reactivation Date:2022-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician