Provider Demographics
NPI:1538561550
Name:MOLINA, LORNA I
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:I
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 904
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0904
Mailing Address - Country:US
Mailing Address - Phone:787-410-6339
Mailing Address - Fax:787-410-6339
Practice Address - Street 1:CARR #2 KM 94.3 CALLE ENIO MORALES.
Practice Address - Street 2:BO. YEGUADA (INT)
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-410-6339
Practice Address - Fax:787-410-6339
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR843OtherJUNTA TERAPIA OCUPACIONAL PR