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General NPI Number Information
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NPI Number | 1396559290
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Entity Type | Individual
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Provider Name | GARY CRISTOFER MOLINA FNP
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Gender | Male
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 17075 DEVONSHIRE ST STE 201
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City | NORTHRIDGE
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State | CA
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Zip | 91325-5407
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Country | US
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Telephone | 818-923-5453
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Fax |
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Provider Business Mailing Address
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Address Line | 10868 VENA AVE
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City | MISSION HILLS
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State | CA
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Zip | 91345-1837
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Country | US
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Telephone | 818-439-5495
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95031581
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License Number State | CA
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