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General NPI Number Information
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NPI Number | 1720461874
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Entity Type | Individual
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Provider Name | JOSEPH MOLINA PTA
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Gender | Male
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 8730 SANTA MONICA BLVD SUITE G
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4547
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Country | US
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Telephone | 310-659-2740
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Fax | 310-659-2748
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Provider Business Mailing Address
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Address Line | 1227 N GENESEE AVE APT 3
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-4730
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Country | US
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Telephone | 323-401-6513
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT9850
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License Number State | CA
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