Provider Demographics
NPI:1659198521
Name:MOLINA PAZ, MARIO ANDRES
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ANDRES
Last Name:MOLINA PAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 SW 24TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2453
Mailing Address - Country:US
Mailing Address - Phone:305-773-7096
Mailing Address - Fax:
Practice Address - Street 1:12011 SW 24TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2453
Practice Address - Country:US
Practice Address - Phone:305-773-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician