Provider Demographics
NPI:1356426258
Name:MOLINA CUEVAS, DALIZA (PT)
Entity type:Individual
Prefix:
First Name:DALIZA
Middle Name:
Last Name:MOLINA CUEVAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO REXVILLE PARK APTO. I-218
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-539-0431
Mailing Address - Fax:787-870-5922
Practice Address - Street 1:C-1 JARDINES DE TOA ALTA
Practice Address - Street 2:LOTE 7 A
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-5922
Practice Address - Fax:787-870-5922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1166208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2529697OtherLICENSE NUMBER