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General NPI Number Information
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NPI Number | 1992822423
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Entity Type | Organization
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Legal Business Name | J C MOLINA P A
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 29100 S W 172 AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-2528
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Country | US
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Telephone | 786-601-7352
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Fax | 786-601-7364
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Provider Business Mailing Address
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Address Line | 29100 S W 172 AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-2528
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Country | US
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Telephone | 786-601-7352
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Fax | 786-601-7364
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | MRS. NEGUI MOLINA
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Credential | SECRETARY
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Telephone | 786-601-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10336
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License Number State | FL
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