Healthcare Provider Details

I. General information

NPI: 1275988743
Provider Name (Legal Business Name): JOSEPH MOLINA MD PROFESSIONAL ASSOC. FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 S MILITARY TRL
WEST PALM BEACH FL
33415-3910
US

IV. Provider business mailing address

9276 SCRANTON RD SUITE 100
SAN DIEGO CA
92121-7701
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-4081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME114917
License Number StateFL

VIII. Authorized Official

Name: KENNY HEINE
Title or Position: VP OF OPERATIONS
Credential:
Phone: 858-964-1506