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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
790 E FOOTHILL BLVD, SUITE D, RIALTO, CA 92376-5269
(909) 546-7135
(877) 778-9467
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
—
CA
208000000X
Pediatrics Physician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APPROVED EFF: 2/1/12
MEDI-CAL
CA
01
—
DU4034-EFF. 3/5/12
RAILROAD MEDICARE
CA
Enumeration date
01/27/2012
Last updated
02/07/2018
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