MEDICARE: MR. DAVID ULISES MOLINA PA-C

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	363A00000X	Physician Assistant	PA.0004669	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1081029	OTHER		NCCPA

General Provider Information

NPI Number	:	1225202740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ULISES MOLINA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 49551
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80949-9551
Country	:	US
Telephone Number	:	719-505-6118
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 RINGSBY CT STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4923
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:	720-598-0440

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

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	07/02/2020

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