Provider Demographics
NPI:1952516288
Name:MOLINA HEALTHCARE OF CALIFORNIA
Entity Type:Organization
Organization Name:MOLINA HEALTHCARE OF CALIFORNIA
Other - Org Name:MOLINA MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STRATEGIC PLANNER, RESEARCH & DEV.
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-499-6191
Mailing Address - Street 1:MOLINA MEDICAL CENTERS - SMO
Mailing Address - Street 2:ONE GOLDEN SHORE
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4202
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:MOLINA MEDICAL CENTERS - SMO
Practice Address - Street 2:954 SACRAMENTO AVENUE
Practice Address - City:W. SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-1904
Practice Address - Country:US
Practice Address - Phone:916-373-1495
Practice Address - Fax:916-373-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR004265MMedicaid
CAZZZ35914ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER