Provider Demographics
NPI:1740606870
Name:MOLINA, SOPHIA LAZO (NP-C)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:LAZO
Last Name:MOLINA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4250
Mailing Address - Country:US
Mailing Address - Phone:949-493-6113
Mailing Address - Fax:949-493-5851
Practice Address - Street 1:724 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4250
Practice Address - Country:US
Practice Address - Phone:949-493-6113
Practice Address - Fax:949-493-5851
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816370163W00000X
CA95000470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse