Provider Demographics
NPI:1497195770
Name:MOLINA, JASON RAYMOND (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RAYMOND
Last Name:MOLINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11639 CREEKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6338
Mailing Address - Country:US
Mailing Address - Phone:858-344-4989
Mailing Address - Fax:
Practice Address - Street 1:11639 CREEKSTONE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6338
Practice Address - Country:US
Practice Address - Phone:858-344-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40474225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist