Provider Demographics
NPI:1649771858
Name:MOLINO, MICHAEL (SLP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOLINO
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5599 LATIN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2926
Mailing Address - Country:US
Mailing Address - Phone:951-973-9369
Mailing Address - Fax:
Practice Address - Street 1:2530 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3989
Practice Address - Country:US
Practice Address - Phone:916-797-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist