MEDICARE: MARTIN C MOLINA M.D.

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	207Q00000X	Family Medicine Physician	M0185	TX

General Provider Information

NPI Number	:	1700830338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN C MOLINA M.D.

Provider Business Mailing Address
First Line	:	6618 SITIO DEL RIO BLVD
Second Line	:	BLDG B101
City	:	AUSTIN
State	:	TX
Zip	:	78730-1143
Country	:	US
Telephone Number	:	512-524-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	6618 SITIO DEL RIO BLVD
Second Line	:	BLDG. B-101
City	:	AUSTIN
State	:	TX
Zip	:	78730-1143
Country	:	US
Telephone Number	:	512-524-2336
Fax Number	:	512-372-8525

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/02/2015

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