Provider Demographics
NPI:1912130790
Name:MOLMENTI, LUIS AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:AUGUSTO
Last Name:MOLMENTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEYDEN ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8305
Mailing Address - Country:US
Mailing Address - Phone:617-821-5581
Mailing Address - Fax:
Practice Address - Street 1:25 LEYDEN ST
Practice Address - Street 2:APT 2E
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8305
Practice Address - Country:US
Practice Address - Phone:617-821-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2065092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry