Provider Demographics
NPI:1750575932
Name:MOLINA, SUSAN RICE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RICE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3618 LANTANA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2247
Mailing Address - Country:US
Mailing Address - Phone:561-296-1188
Mailing Address - Fax:
Practice Address - Street 1:3618 LANTANA RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2247
Practice Address - Country:US
Practice Address - Phone:561-296-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant