Joseph M Molina MD Professional Corporation - Southern California

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JOSEPH M MOLINA MD PROFESSIONAL CORPORATION - SOUTHERN CALIFORNIA

Doing business as

Molina Medical Group of Southern California

Practice address

2196 West 3500 South, Suite C1
West Valley City, UT 84119-3463

Phone

(562) 499-6191

Fax

(562) 499-6171

NPI assigned

Nov 22, 2013

Last updated

May 27, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gloria Calderon

Title

VP, Clinic Operations

Phone

(562) 499-6191

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Molina Medical Group of Southern California Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1063842334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2196 WEST 3500 SOUTH, SUITE C1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193463",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH M MOLINA MD PROFESSIONAL CORPORATION - SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "CALDERON",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "VP, CLINIC OPERATIONS",
        "authorized_official_telephone_number": "562-499-6191"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF. 1/6/14",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Molina Medical Group of Southern California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.