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Organization
MOLINA MEDICAL GROUP OF NEW MEXICO, PC
Active
Organization
MOLINA MEDICAL GROUP OF NEW MEXICO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VP, CLINIC OPERATIONS)
(562) 499-6191
Entity
Organization
Contact information
Practice address
200 OCEANGATE STE 100, LONG BEACH, CA 90802-4317
(562) 499-6191
Mailing address
1714 SAINT MICHAELS DR # 1, SANTA FE, NM 87505-7617
(505) 490-4042
(877) 846-3680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CA
208000000X
Pediatrics Physician
—
CA
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
CA
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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