Provider Demographics
NPI:1417106683
Name:MOLINA, JORGE L (PA-C)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:RM 4302
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5071
Mailing Address - Country:US
Mailing Address - Phone:520-626-9752
Mailing Address - Fax:520-626-4042
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:RM 4302
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5071
Practice Address - Country:US
Practice Address - Phone:520-626-9752
Practice Address - Fax:520-626-4042
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK84363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical