Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 21985 | WV |
N | 207V00000X | Obstetrician & Gynecologist | 35086645 | OH |
NPI | 1003896796 |
---|---|
Provider Name | Rafael Evencio Molina |
First Address | Huntington, WV 25717-1680 |
Second Address | Huntington, WV 25701-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 13/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000368678 | ANTHEM BC (01) | OH |
001709560 | MT. STATE (01) | WV |
001709561 | MT. STATE (01) | OH |
2613578 | (05) | OH |
3810001850 | (05) | WV |
64107105 | (05) | KY |
I38223 | (02) | WV |