Healthcare Provider Details

I. General information

NPI: 1659897163
Provider Name (Legal Business Name): MOLINA HEALTHCARE OF WASHINGTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 30TH DR SE STE 400
BOTHELL WA
98021-7015
US

IV. Provider business mailing address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax: 844-861-1929
Mailing address:
  • Phone: 888-562-5442
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOSEPH WHITE
Title or Position: MHI-CFO
Credential:
Phone: 562-499-6191