Provider Demographics
NPI:1790197911
Name:LAURIE D MOLINA MD PA
Entity Type:Organization
Organization Name:LAURIE D MOLINA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-265-2272
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 347
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-265-2272
Mailing Address - Fax:281-491-4181
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-265-2272
Practice Address - Fax:281-491-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045243503Medicaid
TX045243504Medicaid