Provider Demographics
NPI:1427114255
Name:MOLINA, MARINO (MD)
Entity type:Individual
Prefix:
First Name:MARINO
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 49TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1963
Mailing Address - Country:US
Mailing Address - Phone:305-681-7789
Mailing Address - Fax:305-681-7968
Practice Address - Street 1:625 E 49TH ST FL 2
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1963
Practice Address - Country:US
Practice Address - Phone:305-681-7789
Practice Address - Fax:305-681-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00679452084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015687500Medicaid
FL27090Medicare ID - Type Unspecified
FLG03505Medicare UPIN