Provider Demographics
NPI:1689375859
Name:MOLINA, MERCEDES GUADALUPE
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:GUADALUPE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E CALLE TRONA
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3727
Mailing Address - Country:US
Mailing Address - Phone:520-425-1196
Mailing Address - Fax:
Practice Address - Street 1:308 E CALLE TRONA
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3727
Practice Address - Country:US
Practice Address - Phone:520-425-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist