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NPI Code Detail

MEDICARE: JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA

MEDICARE: JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN 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
1208000000XPediatrics PhysicianCA
2207Q00000XFamily Medicine PhysicianCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DU4032-EFF. 3/5/12OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891067500
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA
Provider Business Mailing Address
First Line : 625 FAIR OAKS AVE STE 270
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-5801
Country : US
Telephone Number : 626-346-2455
Fax Number : 626-639-3005
Provider Business Practice Location Address
First Line : 1900 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-5502
Country : US
Telephone Number : 562-437-0373
Fax Number : 877-469-3631
Authorized Official
Title or Position : VICE PRESIDENT, CLINIC OPERATIONS
Name : GLORIA CALDERON
Credential :
Telephone Number : 626-346-2455
Provider Enumeration Date : 01/27/2012
Last Update Date : 02/07/2018

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Directions to “JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA ” Practice Location

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