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NPI Code Detail

MEDICARE: DR. LISA JUNE MOLIN

MEDICARE: DR. LISA JUNE MOLIN
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
1174400000XSpecialistA55137CA
2207Y00000XOtolaryngology PhysicianA55137CA

General Provider Information

NPI Number : 1366447138
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA JUNE MOLIN
Provider Business Mailing Address
First Line : 901 OAK PARK BLVD STE 202
Second Line :
City : PISMO BEACH
State : CA
Zip : 93449-3410
Country : US
Telephone Number : 805-481-1368
Fax Number : 805-481-8013
Provider Business Practice Location Address
First Line : 1555 HIGUERA ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2917
Country : US
Telephone Number : 805-541-2368
Fax Number : 805-541-2553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 11/03/2023

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Directions to “ DR. LISA JUNE MOLIN ” Practice Location

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