Healthcare Provider Details

I. General information

NPI: 1225368210
Provider Name (Legal Business Name): MS. MOLLY RAE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 21ST ST 205
SACRAMENTO CA
95811-5220
US

IV. Provider business mailing address

8266 GWINHURST CIR
SACRAMENTO CA
95828-7528
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0123
  • Fax: 916-441-6893
Mailing address:
  • Phone: 916-289-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: