Healthcare Provider Details

I. General information

NPI: 1811124928
Provider Name (Legal Business Name): ADRIANA MOLINA PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 OLD TOWN AVE STE A208
SAN DIEGO CA
92110-2967
US

IV. Provider business mailing address

PO BOX 3256
RANCHO SANTA FE CA
92067
US

V. Phone/Fax

Practice location:
  • Phone: 858-876-3131
  • Fax: 858-876-3131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY18612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: