Provider Demographics
NPI:1538685524
Name:MOLINOS, NICOLE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MOLINOS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5963
Mailing Address - Country:US
Mailing Address - Phone:619-698-2184
Mailing Address - Fax:
Practice Address - Street 1:6942 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5963
Practice Address - Country:US
Practice Address - Phone:619-698-2184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA166790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics