MEDICARE: JORGE L 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	363AS0400X	Surgical Physician Assistant	84	OK

General Provider Information

NPI Number	:	1417106683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE L MOLINA PA-C

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	RM 4302
City	:	TUCSON
State	:	AZ
Zip	:	85724-5071
Country	:	US
Telephone Number	:	520-626-9752
Fax Number	:	520-626-4042

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	RM 4302
City	:	TUCSON
State	:	AZ
Zip	:	85724-5071
Country	:	US
Telephone Number	:	520-626-9752
Fax Number	:	520-626-4042

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	07/18/2016

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