Provider Demographics
NPI:1336340728
Name:MOLINA, FREDDY
Entity Type:Individual
Prefix:MS
First Name:FREDDY
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
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 1404
Mailing Address - Street 2:SABANA SECA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00952
Mailing Address - Country:US
Mailing Address - Phone:787-479-3763
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 687 PARCELA 136 BO SABANA SECA
Practice Address - Street 2:SABANA SECA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00952
Practice Address - Country:US
Practice Address - Phone:787-479-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5540183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5540Other5540