Healthcare Provider Details

I. General information

NPI: 1114892007
Provider Name (Legal Business Name): CLINIQUE MOLIERE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S BREA BLVD
BREA CA
92821-5310
US

IV. Provider business mailing address

2114 N WRIGHT ST
SANTA ANA CA
92705-7159
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-5655
  • Fax: 657-204-8992
Mailing address:
  • Phone: 714-948-5655
  • Fax: 657-204-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE MOLIERE
Title or Position: OWNER
Credential:
Phone: 714-948-5655