Provider Demographics
NPI:1083853311
Name:MOLINA, ALBERT MANUEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:MANUEL
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1001 POINDEXTER ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2444
Mailing Address - Country:US
Mailing Address - Phone:757-494-1688
Mailing Address - Fax:757-494-1973
Practice Address - Street 1:1001 POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2444
Practice Address - Country:US
Practice Address - Phone:757-494-1688
Practice Address - Fax:757-494-1973
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant