Healthcare Provider Details

I. General information

NPI: 1013929512
Provider Name (Legal Business Name): MARIA MOLA PARENT PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 LA CRESCENTA AVE STE 101
GLENDALE CA
91208-1546
US

IV. Provider business mailing address

3786 LA CRESCENTA AVE STE 101
GLENDALE CA
91208-1059
US

V. Phone/Fax

Practice location:
  • Phone: 818-541-9276
  • Fax: 818-241-5785
Mailing address:
  • Phone: 818-541-9276
  • Fax: 818-241-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: