Healthcare Provider Details

I. General information

NPI: 1588552970
Provider Name (Legal Business Name): ALISA KATHARINE MOLINA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST STE 2
POMONA CA
91766-2007
US

IV. Provider business mailing address

280 E DEL MAR BLVD APT 330
PASADENA CA
91101-2746
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6116
  • Fax:
Mailing address:
  • Phone: 949-633-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number36034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: