=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265477756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIO MOLINA M.D., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 12/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 MAIN ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-342-6595
-----------------------------------------------------
Fax | 281-232-4010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 MAIN ST STE 301
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-342-6595
-----------------------------------------------------
Fax | 281-232-4010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. JULIO C MOLINA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-342-6595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD5010
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------