Provider Demographics
NPI:1063446953
Name:MOLINA, RICARDO A (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:A
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:ANTONIO
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:39350 CIVIC CENTER DR. STE. 300
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2331
Mailing Address - Country:US
Mailing Address - Phone:510-797-3922
Mailing Address - Fax:510-797-5184
Practice Address - Street 1:39350 CIVIC CENTER DR. STE. 300
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2331
Practice Address - Country:US
Practice Address - Phone:510-797-3922
Practice Address - Fax:510-797-5184
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA108732207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program