Provider Demographics
NPI:1770547523
Name:MOLINA, JOHN M (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MOLINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3743 S PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7463
Mailing Address - Country:US
Mailing Address - Phone:714-332-1803
Mailing Address - Fax:714-332-1811
Practice Address - Street 1:847 PALMYRITA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-1805
Practice Address - Country:US
Practice Address - Phone:714-332-1803
Practice Address - Fax:714-332-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2015-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100300Medicaid
CAGR0100300Medicaid
I101908Medicare UPIN