Provider Demographics
NPI:1245061746
Name:MOLINA'S MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MOLINA'S MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-294-2772
Mailing Address - Street 1:5600 SW 135TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5101
Mailing Address - Country:US
Mailing Address - Phone:305-603-9261
Mailing Address - Fax:305-603-9283
Practice Address - Street 1:5600 SW 135TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5101
Practice Address - Country:US
Practice Address - Phone:305-603-9261
Practice Address - Fax:305-603-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service