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General NPI Number Information
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NPI Number | 1760813521
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Entity Type | Individual
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Provider Name | RYAN P MOLINA C.O.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 2824 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3400
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Country | US
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Telephone | 626-431-2890
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Fax | 626-431-2892
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Provider Business Mailing Address
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Address Line | 2824 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3400
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Country | US
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Telephone | 626-431-2890
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Fax | 626-431-2892
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CO003823
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License Number State | CA
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