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 State
1	207R00000X	Internal Medicine Physician	CA
2	208000000X	Pediatrics Physician	CA
3	207Q00000X	Family Medicine Physician	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DU4032-EFF. 3/5/12	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1982976692
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	:	445 E. ANAHEIM STREET, #H
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-4600
Country	:	US
Telephone Number	:	310-518-6146
Fax Number	:	877-469-1428

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	:	02/08/2018

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

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