Provider Demographics
NPI:1356561104
Name:MOLINA, LOURDES CORDERO (MS)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:CORDERO
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E1 CALLE CEIBA
Mailing Address - Street 2:URB. EL PLANTIO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4484
Mailing Address - Country:US
Mailing Address - Phone:787-613-1258
Mailing Address - Fax:
Practice Address - Street 1:E1 CALLE CEIBA
Practice Address - Street 2:URB. EL PLANTIO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4484
Practice Address - Country:US
Practice Address - Phone:787-613-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical