Healthcare Provider Details

I. General information

NPI: 1720024680
Provider Name (Legal Business Name): EDUARDO MOLINET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST STE 1600
LOS ANGELES CA
90033-5310
US

IV. Provider business mailing address

PO BOX 31399
LOS ANGELES CA
90031-0399
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-5842
  • Fax:
Mailing address:
  • Phone: 626-457-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG60364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: