Healthcare Provider Details

I. General information

NPI: 1437763224
Provider Name (Legal Business Name): MOLA MEDICAL PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 300
BEVERLY HILLS CA
90210-6814
US

IV. Provider business mailing address

415 N CRESCENT DR STE 300
BEVERLY HILLS CA
90210-6814
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-9191
  • Fax:
Mailing address:
  • Phone: 310-657-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ARIEL WEEKS
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 818-921-4127