Provider Demographics
NPI:1700207677
Name:MOLINA PROSTHETICS & ORTHOTICS
Entity Type:Organization
Organization Name:MOLINA PROSTHETICS & ORTHOTICS
Other - Org Name:ADVANCED KINEMATICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF PROSTHETIC & ORTHOTICS
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:760-964-3030
Mailing Address - Street 1:2222 MARTIN STE 212
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1434
Mailing Address - Country:US
Mailing Address - Phone:949-988-7928
Mailing Address - Fax:949-861-9539
Practice Address - Street 1:2222 MARTIN STE 212
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1434
Practice Address - Country:US
Practice Address - Phone:949-988-7928
Practice Address - Fax:949-861-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier