Provider Demographics
NPI:1275542672
Name:MOLINA, ORESTES (MD)
Entity Type:Individual
Prefix:
First Name:ORESTES
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 POINT FOSDICK DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1700
Mailing Address - Country:US
Mailing Address - Phone:253-530-8122
Mailing Address - Fax:
Practice Address - Street 1:4545 POINT FOSDICK DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1700
Practice Address - Country:US
Practice Address - Phone:253-530-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4370207V00000X
WAMD60140048207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182511902Medicaid
TXP0147658OtherDPS
TXM4370OtherMEDICAL LICENSE
FLME95814OtherMEDICAL LICENSE
TXBM9749271OtherDEA
TXM4370OtherMEDICAL LICENSE
TXP0147658OtherDPS