Provider Demographics
NPI:1609597269
Name:MOLINA, JONATHAN PATRON
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PATRON
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 W POINT LOMA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5643
Mailing Address - Country:US
Mailing Address - Phone:619-302-4353
Mailing Address - Fax:
Practice Address - Street 1:521 VALENCIA PKWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-6531
Practice Address - Country:US
Practice Address - Phone:619-302-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician