MEDICARE: JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA

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	208000000X	Pediatrics Physician		CA
2	207Q00000X	Family Medicine Physician		CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DU4032-EFF. 3/24/12	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215208962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	625 FAIR OAKS AVE STE 270
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5801
Country	:	US
Telephone Number	:	626-346-2455
Fax Number	:	626-639-3005

Provider Business Practice Location Address
First Line	:	540 E. ARTESIA BOULEVARD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1476
Country	:	US
Telephone Number	:	562-423-7802
Fax Number	:	877-469-3649

Authorized Official
Title or Position	:	VICE PRESIDENT, CLINIC OPERATIONS
Name	:	GLORIA CALDERON
Credential	:
Telephone Number	:	626-346-2455

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	02/07/2018

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Directions to “JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA ” Practice Location

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