Healthcare Provider Details

I. General information

NPI: 1861585887
Provider Name (Legal Business Name): ERIC MARTIN MOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT SREET
VENTURA CA
93003
US

IV. Provider business mailing address

PO BOX 920125
DALLAS TX
75392-0125
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5011
  • Fax: 805-585-3007
Mailing address:
  • Phone: 877-346-2211
  • Fax: 407-324-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG68497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: