MEDICARE: PATRICK M MOLONEY

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	207RC0000X	Cardiovascular Disease Physician	A32611	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952440885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK M MOLONEY

Provider Business Mailing Address
First Line	:	399 E HIGHLAND AVE
Second Line	:	#209
City	:	SAN BERNANDINO
State	:	CA
Zip	:	92404-3848
Country	:	US
Telephone Number	:	909-883-8938
Fax Number	:	909-883-1739

Provider Business Practice Location Address
First Line	:	399 E HIGHLAND AVE
Second Line	:	#209
City	:	SAN BERNANDINO
State	:	CA
Zip	:	92404-3848
Country	:	US
Telephone Number	:	909-883-8938
Fax Number	:	909-883-1739

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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