Provider Demographics
NPI:1639170236
Name:MOLINA, LAURIE D (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 STRATFORD GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4252
Mailing Address - Country:US
Mailing Address - Phone:281-313-3206
Mailing Address - Fax:
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-265-2272
Practice Address - Fax:281-491-4181
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045243503Medicaid
8C1631Medicare ID - Type Unspecified
TX045243503Medicaid