Provider Demographics
NPI:1831297159
Name:MOLINA, MELISSA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 SUNLAND PARK DR SUITE 100 BLDG 6
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8427
Mailing Address - Country:US
Mailing Address - Phone:915-594-4475
Mailing Address - Fax:915-577-8334
Practice Address - Street 1:9100 VISCOUNT BLVD STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6529
Practice Address - Country:US
Practice Address - Phone:915-594-4475
Practice Address - Fax:915-577-8334
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1442774-01Medicaid
TX1442774-01Medicaid
TX00241QMedicare PIN
TX00241QMedicare ID - Type Unspecified