Provider Demographics
NPI:1003136185
Name:MOLINA, MARYLU (MSW)
Entity Type:Individual
Prefix:
First Name:MARYLU
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 S CURSON AVE LBBY ROOM
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5252
Mailing Address - Country:US
Mailing Address - Phone:323-936-0859
Mailing Address - Fax:
Practice Address - Street 1:535 S CURSON AVE LBBY ROOM
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5252
Practice Address - Country:US
Practice Address - Phone:323-936-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker