Provider Demographics
NPI:1821225780
Name:MOLINAR, TATIANA (MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MOLINAR
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 VENICE BLVD STE 1085
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5127
Mailing Address - Country:US
Mailing Address - Phone:323-419-2676
Mailing Address - Fax:
Practice Address - Street 1:5630 VENICE BLVD STE 1085
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5127
Practice Address - Country:US
Practice Address - Phone:323-419-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA95022470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor