MEDICARE: IRWIN MOLINA CAREGIVER

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1790306942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRWIN MOLINA CAREGIVER

Provider Business Mailing Address
First Line	:	4471 LITTLE MEADOW CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-1928
Country	:	US
Telephone Number	:	650-305-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	4471 LITTLE MEADOW CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-1928
Country	:	US
Telephone Number	:	650-305-6811
Fax Number	:

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

Provider Enumeration Date	:	04/29/2020
Last Update Date	:	04/29/2020

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Directions to “ IRWIN MOLINA CAREGIVER” Practice Location

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