Provider Demographics
NPI:1376697458
Name:MOLINA, DIANA CRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CRISTINA
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10672
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0217
Mailing Address - Country:US
Mailing Address - Phone:714-957-6889
Mailing Address - Fax:714-546-8616
Practice Address - Street 1:1182 SE BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5302
Practice Address - Country:US
Practice Address - Phone:714-957-6889
Practice Address - Fax:714-546-8616
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32884111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32884OtherP.T LICENSE NUMBER