MEDICARE: JEFF 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1386462448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF MOLINA

Provider Business Mailing Address
First Line	:	1459 18TH ST STE 206
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-2801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 N D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-4739
Country	:	US
Telephone Number	:	909-880-3625
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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Directions to “ JEFF MOLINA ” Practice Location

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