Healthcare Provider Details

I. General information

NPI: 1700557907
Provider Name (Legal Business Name): PRISCILLA STEPHANIE MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N HILL AVE STE 100
PASADENA CA
91106-1949
US

IV. Provider business mailing address

901 CENTENNIAL ST APT 7
LOS ANGELES CA
90012-1350
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7700
  • Fax:
Mailing address:
  • Phone: 818-665-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: