Provider Demographics
NPI:1760446926
Name:MOLINA, SALVADOR JR (DO)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:MOLINA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:561-570-5172
Mailing Address - Fax:786-472-5770
Practice Address - Street 1:10435 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7920
Practice Address - Country:US
Practice Address - Phone:915-591-6229
Practice Address - Fax:915-206-6385
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3404207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95706810Medicaid
TXP10334424OtherRAILROAD RETIREMENT MEDICARE
TX1557035-11Medicaid
TX8DZ246OtherBC/BS OF TEXAS
NM95706810Medicaid
TX293990YSXZMedicare PIN
TX155703507Medicaid
TX155703506Medicaid
TX8A7787Medicare ID - Type Unspecified