Provider Demographics
NPI:1932628278
Name:KADIRIRE, MOLIN
Entity type:Individual
Prefix:
First Name:MOLIN
Middle Name:
Last Name:KADIRIRE
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 1:5580 LYNDON B JOHNSON FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-2654
Mailing Address - Country:US
Mailing Address - Phone:214-535-5614
Mailing Address - Fax:
Practice Address - Street 1:2351 W NORTHWEST HWY # 3237
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:469-345-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX310400000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility