Provider Demographics
NPI:1548767890
Name:MOLINA, MONICA MEILYN BOGGS (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MEILYN BOGGS
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR STE 506
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3856
Mailing Address - Country:US
Mailing Address - Phone:714-639-3914
Mailing Address - Fax:714-538-5427
Practice Address - Street 1:1310 W STEWART DR STE 506
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3856
Practice Address - Country:US
Practice Address - Phone:714-639-3914
Practice Address - Fax:714-538-5427
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics