Provider Demographics
NPI:1396559290
Name:MOLINA, GARY CRISTOFER (FNP)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:CRISTOFER
Last Name:MOLINA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10868 VENA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1837
Mailing Address - Country:US
Mailing Address - Phone:818-439-5495
Mailing Address - Fax:
Practice Address - Street 1:17075 DEVONSHIRE ST STE 201
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5407
Practice Address - Country:US
Practice Address - Phone:818-923-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily