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General NPI Number Information
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NPI Number | 1558323857
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Entity Type | Organization
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Legal Business Name | MOLINA MEDICAL MANAGEMENT GROUP.LTD
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1901 W IRVING BLVD SUITE 100
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City | IRVING
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State | TX
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Zip | 75061-6823
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Country | US
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Telephone | 972-259-6900
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Fax | 972-254-5501
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Provider Business Mailing Address
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Address Line | 1901 W IRVING BLVD STE 100
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City | IRVING
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State | TX
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Zip | 75061-6823
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Country | US
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Telephone | 972-259-6900
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Fax | 972-254-5501
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRANDI MICHELE GIBSON
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Credential |
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Telephone | 972-259-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | TX
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