Provider Demographics
NPI:1124329099
Name:MOLINA, CYNTHIA YVONNE (MAC, LAC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YVONNE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 HOGENHILL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2564
Mailing Address - Country:US
Mailing Address - Phone:301-502-9140
Mailing Address - Fax:
Practice Address - Street 1:30 W GUDE DR
Practice Address - Street 2:SUITE 375
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1161
Practice Address - Country:US
Practice Address - Phone:301-502-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist