Provider Demographics
NPI:1669261848
Name:TASH, MOLLY RAE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAE
Last Name:TASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 U ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1732
Mailing Address - Country:US
Mailing Address - Phone:916-317-9400
Mailing Address - Fax:
Practice Address - Street 1:330 MONTROSE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2720
Practice Address - Country:US
Practice Address - Phone:916-351-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant