MEDICARE: MOLINA HEALTHCARE OF 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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician		CA

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	:	1669586020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLINA HEALTHCARE OF CALIFORNIA

Provider Business Mailing Address
First Line	:	200 OCEANGATE
Second Line	:	100
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4317
Country	:	US
Telephone Number	:	562-499-6191
Fax Number	:	562-499-6171

Provider Business Practice Location Address
First Line	:	540 E ARTESIA BL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1476
Country	:	US
Telephone Number	:	562-423-3383
Fax Number	:	877-469-3649

Authorized Official
Title or Position	:	V.P. FINANCE
Name	:	MATTHEW SCHUEREN
Credential	:
Telephone Number	:	888-562-5442

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/06/2017

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Directions to “MOLINA HEALTHCARE OF CALIFORNIA ” Practice Location

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