Provider Demographics
NPI:1871887596
Name:MOLINA, MARIBEL
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
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 571
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-0571
Mailing Address - Country:US
Mailing Address - Phone:787-894-8214
Mailing Address - Fax:787-894-1234
Practice Address - Street 1:AVE. FERNANDO L. RIVAS DOMINNICCI
Practice Address - Street 2:CARR. 111 INT. 611 KM 1.7
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-0571
Practice Address - Country:US
Practice Address - Phone:787-894-8214
Practice Address - Fax:787-894-1234
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRZUA9092153170400OtherTRIPLE S BLUE CROSS BLUE SHIELD