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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
Molina Medical Group of Southern CA
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VICE PRESIDENT, CLINIC OPERATIONS)
(562) 491-7053
Entity
Organization
Contact information
Practice address
1181 N MOUNT VERNON AVE, COLTON, CA 92324-2574
(909) 498-2356
(877) 824-9080
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4302
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DU5182-EFF 8/5/13
RAILROAD MEDICARE
CA
05
—
EFFECTIVE 10/21/13
—
CA
Enumeration date
10/19/2012
Last updated
06/02/2014
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