Healthcare Provider Details

I. General information

NPI: 1770698987
Provider Name (Legal Business Name): MOLINA HEALTHCARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 NORWOOD AVE
SACRAMENTO CA
95838-3300
US

IV. Provider business mailing address

200 OCEANGATE, SUITE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-0521
  • Fax: 877-860-2907
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MATTHEW SCHUEREN
Title or Position: V.P. FINANCE
Credential:
Phone: 888-562-5442