Provider Demographics
NPI:1760055677
Name:MOLINA MOYANO, IGNACIO
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:MOLINA MOYANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 IRON HORSE PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2043
Mailing Address - Country:US
Mailing Address - Phone:925-918-3142
Mailing Address - Fax:
Practice Address - Street 1:6117 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1240
Practice Address - Country:US
Practice Address - Phone:510-655-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor