Provider Demographics
NPI:1154162386
Name:MOLINA PONCE, MEIBYS
Entity type:Individual
Prefix:
First Name:MEIBYS
Middle Name:
Last Name:MOLINA PONCE
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 1:1100 W 79TH ST APT B6
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3582
Mailing Address - Country:US
Mailing Address - Phone:954-743-7202
Mailing Address - Fax:
Practice Address - Street 1:1100 W 79TH ST APT B6
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3582
Practice Address - Country:US
Practice Address - Phone:954-743-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-346380106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician