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General NPI Number Information
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NPI Number | 1417106683
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Entity Type | Individual
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Provider Name | JORGE L MOLINA PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 1501 N CAMPBELL AVE RM 4302
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City | TUCSON
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State | AZ
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Zip | 85724-5071
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Country | US
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Telephone | 520-626-9752
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Fax | 520-626-4042
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Provider Business Mailing Address
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Address Line | 1501 N CAMPBELL AVE RM 4302
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City | TUCSON
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State | AZ
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Zip | 85724-5071
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Country | US
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Telephone | 520-626-9752
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Fax | 520-626-4042
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 84
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License Number State | OK
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