Healthcare Provider Details

I. General information

NPI: 1588879936
Provider Name (Legal Business Name): MOLINA HEALTHCARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOLINA MEDICAL CENTERS - SMO 3946 NORWOOD AVENUE
SACRAMENTO CA
95838-3300
US

IV. Provider business mailing address

MOLINA MEDICAL CENTERS - SMO ONE GOLDEN SHORE
LONG BEACH CA
90802-4202
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-0521
  • Fax: 916-564-1528
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS WAYNE EVANS
Title or Position: STRATEGIC PLANER, RESEARCH AND DEV.
Credential:
Phone: 562-499-6191