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General NPI Number Information
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NPI Number | 1376843334
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Entity Type | Organization
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Legal Business Name | MOLINA HEALTHCARE OF CALIFORNIA
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 790 E. FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376
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Country | US
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Telephone | 909-237-2438
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Fax | 562-499-6171
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE SUITE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 562-499-6191
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Fax | 562-499-6171
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Authorized Official
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Title or Position | VP CLINIC OPERATIONS
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Name | GLORIA CALDERON
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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