Healthcare Provider Details

I. General information

NPI: 1124092556
Provider Name (Legal Business Name): MOLINA BHATNAGAR DAYAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 NEW BALLAS RD STE 150
ST. LOUIS MO
63141
US

IV. Provider business mailing address

5320 S. RAINBOW BLVD STE 300
LAS VEGAS NV
89119-1840
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-9000
  • Fax: 314-983-9023
Mailing address:
  • Phone: 702-794-0073
  • Fax: 701-794-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2012022438
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier034864300
Identifier TypeMEDICAID
Identifier StateDC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: