Provider Demographics
NPI:1730980160
Name:MOLINA GAINZA, LISANDRA M
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:M
Last Name:MOLINA GAINZA
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 1:1112 W 44TH ST APT 89
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4175
Mailing Address - Country:US
Mailing Address - Phone:786-992-3447
Mailing Address - Fax:
Practice Address - Street 1:1112 W 44TH ST APT 89
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4175
Practice Address - Country:US
Practice Address - Phone:786-992-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician