Healthcare Provider Details

I. General information

NPI: 1588803837
Provider Name (Legal Business Name): ROBERTO A MOLINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 COLONIA DE SALUD SUITE 200C
SIERRA VISTA AZ
85635-2487
US

IV. Provider business mailing address

5750 E HIGHWAY 90 STE 200
SIERRA VISTA AZ
85635-9113
US

V. Phone/Fax

Practice location:
  • Phone: 520-335-2800
  • Fax: 520-335-2964
Mailing address:
  • Phone: 520-263-3979
  • Fax: 520-263-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: