Healthcare Provider Details

I. General information

NPI: 1689788085
Provider Name (Legal Business Name): MOLINA HEALTHCARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 FOOTHILL BLVD STE A2
FONTANA CA
92335-3798
US

IV. Provider business mailing address

200 OCEANGATE #100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 908-428-0170
  • Fax: 877-778-9312
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SCHUEREN
Title or Position: V.P. FINANCE
Credential:
Phone: 888-562-5442