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General NPI Number Information
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NPI Number | 1871045385
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Entity Type | Organization
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Legal Business Name | MOLINA PSYCHOLOGICAL CONSULTANTS
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 18 MONROVIA
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City | IRVINE
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State | CA
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Zip | 92602-0925
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Country | US
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Telephone | 714-267-4424
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 BUSINESS CENTER DR SUITE 130
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City | IRVINE
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State | CA
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Zip | 92612-1001
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Country | US
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Telephone | 714-267-4424
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MICHELLE MOLINA
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Credential | PH.D.
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Telephone | 714-267-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | PSY 18195
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License Number State | CA
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