Organization
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA
Active
Other names
Molina Medical Group of Southern California
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VICE PRESIDENT-CLINIC OPERATIONS)
(562) 491-7053
Entity
Organization
Contact information
Practice address
15 SW EVERETT MALL WAY, SUITE A, EVERETT, WA 98204-2715
(425) 348-6727
(877) 860-2991
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WA
207R00000X
Internal Medicine Physician
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPROVED/PROVIDERONE
—
CA
Enumeration date
01/27/2012
Last updated
06/18/2013
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