Provider Demographics
NPI:1083729206
Name:MOLINA MEDICAL CENTERS
Entity Type:Organization
Organization Name:MOLINA MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STRATEGIC PLANNER, RESEARCH AND DEV
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-499-6191
Mailing Address - Street 1:ONE GOLDEN SHORE
Mailing Address - Street 2:MOLINA MEDICAL CENTERS SMO
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4202
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:
Practice Address - Street 1:3 COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3111
Practice Address - Country:US
Practice Address - Phone:530-668-9293
Practice Address - Fax:530-668-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35916ZMedicare ID - Type Unspecified