Provider Demographics
NPI:1023340668
Name:BENTON-MOLINA, ANGELICA (LAC)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:BENTON-MOLINA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W BELLFORT ST
Mailing Address - Street 2:#319
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5026
Mailing Address - Country:US
Mailing Address - Phone:832-885-0606
Mailing Address - Fax:
Practice Address - Street 1:5009 CAROLINE ST
Practice Address - Street 2:201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5715
Practice Address - Country:US
Practice Address - Phone:281-974-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist