Provider Demographics
NPI:1073673364
Name:MOLLET, ALLISON RIVERA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RIVERA
Last Name:MOLLET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RIVERA
Other - Last Name:MERRIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:255 W CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3373
Mailing Address - Country:US
Mailing Address - Phone:714-582-2530
Mailing Address - Fax:
Practice Address - Street 1:255 W CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3373
Practice Address - Country:US
Practice Address - Phone:714-582-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16578363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical