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General NPI Number Information
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NPI Number | 1083729206
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Entity Type | Organization
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Legal Business Name | MOLINA MEDICAL CENTERS
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 COURT ST
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City | WOODLAND
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State | CA
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Zip | 95695-3111
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Country | US
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Telephone | 530-668-9293
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Fax | 530-668-0231
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Provider Business Mailing Address
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Address Line | ONE GOLDEN SHORE MOLINA MEDICAL CENTERS SMO
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City | LONG BEACH
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State | CA
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Zip | 90802-4202
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Country | US
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Telephone | 562-499-6191
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Fax |
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Authorized Official
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Title or Position | STRATEGIC PLANNER, RESEARCH AND DEV
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Name | DENNIS WAYNE EVANS
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Credential |
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Telephone | 562-499-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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