Healthcare Provider Details

I. General information

NPI: 1851440705
Provider Name (Legal Business Name): HECTOR H MOLINA LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 N MESA ST
EL PASO TX
79902-4018
US

IV. Provider business mailing address

1517 N MESA ST
EL PASO TX
79902-4018
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-0269
  • Fax: 915-542-0413
Mailing address:
  • Phone: 915-533-0269
  • Fax: 915-542-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00183
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: