Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | PA9111481 | FL |
NPI | 1235611815 |
---|---|
Provider Name | Mr. Peter Danger Molina |
First Address | Miami Lakes, FL 33016-5861 |
Second Address | Miami, FL 33150-2064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 03/12/2019 |