Provider Demographics
NPI:1720424096
Name:JOSEPH M MOLINA MD PROFESSIONAL ASSOCIATION - FLORIDA
Entity Type:Organization
Organization Name:JOSEPH M MOLINA MD PROFESSIONAL ASSOCIATION - FLORIDA
Other - Org Name:MOLINA MEDICAL GROUP OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-491-7053
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:944 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3910
Practice Address - Country:US
Practice Address - Phone:561-223-4081
Practice Address - Fax:877-778-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007624800-EF12/21/12Medicaid
FLDV3514- EFF 7/31/12OtherRAILROAD MEDICARE
FLHK725AMedicare PIN