MEDICARE: NICOLE MOLINOS MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A166790	CA

General Provider Information

NPI Number	:	1538685524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MOLINOS MD, MPH

Provider Business Mailing Address
First Line	:	6942 UNIVERSITY AVE STE A
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-5963
Country	:	US
Telephone Number	:	619-698-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	6942 UNIVERSITY AVE STE A
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-5963
Country	:	US
Telephone Number	:	619-698-2184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	09/18/2020

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