Healthcare Provider Details

I. General information

NPI: 1548593619
Provider Name (Legal Business Name): CLAUDIA B MOLINA CLEMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 E 57TH ST
TACOMA WA
98404-2519
US

IV. Provider business mailing address

1016 E 57TH ST
TACOMA WA
98404-2519
US

V. Phone/Fax

Practice location:
  • Phone: 360-852-1660
  • Fax:
Mailing address:
  • Phone: 360-852-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC56814
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: