Provider Demographics
NPI:1538150743
Name:MOLINA, ADALBERTO (OD)
Entity type:Individual
Prefix:
First Name:ADALBERTO
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE GANDARA
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1984
Mailing Address - Country:US
Mailing Address - Phone:787-859-5959
Mailing Address - Fax:787-859-5959
Practice Address - Street 1:1 CALLE GANDARA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1984
Practice Address - Country:US
Practice Address - Phone:787-859-5959
Practice Address - Fax:787-859-5959
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR0394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
58146Medicare ID - Type Unspecified