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General NPI Number Information
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NPI Number | 1700207677
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Entity Type | Organization
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Legal Business Name | MOLINA PROSTHETICS & ORTHOTICS
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 2222 MARTIN STE 212
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City | IRVINE
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State | CA
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Zip | 92612-1434
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Country | US
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Telephone | 949-988-7928
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Fax | 949-861-9539
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Provider Business Mailing Address
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Address Line | 2222 MARTIN STE 212
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City | IRVINE
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State | CA
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Zip | 92612-1434
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Country | US
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Telephone | 949-988-7928
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Fax | 949-861-9539
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Authorized Official
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Title or Position | DIRECTOR OF PROSTHETIC & ORTHOTICS
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Name | MR. RUSSELL JOHN MOLINA
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Credential | C.P.O.
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Telephone | 760-964-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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