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General NPI Number Information
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NPI Number | 1245475748
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Entity Type | Individual
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Provider Name | ROGER MOLINA CPO
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Gender | Male
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 609 E. ORANGEBURG AVENUE SUITE 102
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City | MODESTO
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State | CA
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Zip | 95350-5512
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Country | US
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Telephone | 209-526-1721
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Fax | 209-526-1740
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Provider Business Mailing Address
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Address Line | 1700 N. CHRISMAN ROAD
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City | TRACY
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State | CA
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Zip | 95304-9314
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Country | US
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Telephone | 209-526-1721
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Fax | 209-526-1740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CPO00577
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | CPO0057
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | CPO0057
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License Number State | CA
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