Provider Demographics
NPI:1598253650
Name:MOLINA, PAUL TAYAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TAYAS
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 6TH ST NW APT 53
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5902
Mailing Address - Country:US
Mailing Address - Phone:949-231-2809
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY STE 195
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:949-679-3336
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty