Provider Demographics
NPI:1376667568
Name:MOLINA DE BRIONES, DULCE (ND, PA-C)
Entity Type:Individual
Prefix:DR
First Name:DULCE
Middle Name:
Last Name:MOLINA DE BRIONES
Suffix:
Gender:F
Credentials:ND, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 AVENIDA VISTA HERMOSA STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6340
Mailing Address - Country:US
Mailing Address - Phone:949-240-2030
Mailing Address - Fax:
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA STE 250
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6340
Practice Address - Country:US
Practice Address - Phone:949-240-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19015363AM0700X
CAND1213175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAND1213OtherLICENSE
CAPA19015OtherLICENSE
CA1075797OtherNCCPA CERTIFICATE #