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Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION - SOUTHERN CALIFORNIA
Active
Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION - SOUTHERN CALIFORNIA
Active
Other names
Golden Shore Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VICE PRESIDENT, CLINIC OPERATIONS)
(626) 346-2455
Entity
Organization
Contact information
Practice address
14544 7TH ST, VICTORVILLE, CA 92395-4214
(562) 499-6191
(562) 499-6191
Mailing address
625 FAIR OAKS AVE STE 270, SOUTH PASADENA, CA 91030-5801
(626) 346-2455
(626) 639-3005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DU5182-EFF 8/5/13
RAILROAD MEDICARE
CA
05
—
EFF: 10/21/13
—
CA
Enumeration date
04/16/2013
Last updated
02/07/2018
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