Provider Demographics
NPI:1043480171
Name:MARTIN C. MOLINA, MD,PA
Entity Type:Organization
Organization Name:MARTIN C. MOLINA, MD,PA
Other - Org Name:TEXAS FAMILY PHYSICIANS @ RIVER PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-524-2336
Mailing Address - Street 1:6618 SITIO DEL RIO BLVD
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1143
Mailing Address - Country:US
Mailing Address - Phone:512-524-2336
Mailing Address - Fax:
Practice Address - Street 1:6618 SITIO DEL RIO BLVD
Practice Address - Street 2:SUITE B-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1143
Practice Address - Country:US
Practice Address - Phone:512-524-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0185261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI13543Medicare UPIN