Provider Demographics
NPI:1720461874
Name:MOLINA, JOSEPH (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 N GENESEE AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4730
Mailing Address - Country:US
Mailing Address - Phone:323-401-6513
Mailing Address - Fax:
Practice Address - Street 1:8730 SANTA MONICA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4547
Practice Address - Country:US
Practice Address - Phone:310-659-2740
Practice Address - Fax:310-659-2748
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT9850225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant