MEDICARE: MR. JOAQUIN MOLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP2201X	Ambulatory Care Registered Nurse	589542	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	589542	OTHER	TX	RN

General Provider Information

NPI Number	:	1114022902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOAQUIN MOLINA

Provider Business Mailing Address
First Line	:	1629 TREASURE HILLS BLVD
Second Line	:	SUITE B-5
City	:	HARLJINGEN
State	:	TN
Zip	:	78550-8907
Country	:	US
Telephone Number	:	956-366-4500
Fax Number	:	956-366-4501

Provider Business Practice Location Address
First Line	:	1629 TREASURE HILLS BLVD
Second Line	:	SUITE B-5
City	:	HARLJINGEN
State	:	TN
Zip	:	78550-8907
Country	:	US
Telephone Number	:	956-366-4500
Fax Number	:	956-366-4501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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