Provider Demographics
NPI:1700025103
Name:MOLINA, RICHELLE MAE SAN JOSE (DPT)
Entity Type:Individual
Prefix:
First Name:RICHELLE MAE
Middle Name:SAN JOSE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:1932 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-630-2258
Practice Address - Fax:760-630-5367
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0246125OtherSTATE OF WASHINGTON DEPT. OF LABOR AND INDUSTRIES
CABM691YMedicare PIN
0246125OtherSTATE OF WASHINGTON DEPT. OF LABOR AND INDUSTRIES
CABM691ZMedicare PIN