Active NPI
Joseph M Molina MD Professional Corporation-Southern California
- Family Medicine Physician
- Fontana, CA
National Provider Identifier
1922379668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA
- Practice address
- 17500 Foothill Blvd
#A-2
Fontana, CA 92335-3798 - Phone
- (909) 428-0170
- Fax
- (877) 778-9312
- NPI assigned
- Jan 25, 2012
- Last updated
- Feb 7, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gloria Calderon
- Title
- Vice President, Clinic Operations
- Phone
- (626) 346-2455
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CA | Primary | |
| Pediatrics Physician | 208000000X | CA |
Addresses
Primary practice location
17500 Foothill Blvd
#A-2
Fontana, CA 92335-3798
Mailing address
625 Fair Oaks Ave Ste 270
South Pasadena, CA 91030-5801
Phone (626) 346-2455
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DU4034-EFF. 3/10/12 | Other | CA | RAILROAD MEDICARE |
| APPROVED EFF 1/31/12 | Medicaid | CA |
Other names 1
- Golden Shore Medical Group
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1517961600000",
"number": "1922379668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 FAIR OAKS AVE STE 270",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910305801",
"telephone_number": "626-346-2455",
"fax_number": "626-639-3005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17500 FOOTHILL BLVD",
"address_2": "#A-2",
"city": "FONTANA",
"state": "CA",
"postal_code": "923353798",
"telephone_number": "909-428-0170",
"fax_number": "877-778-9312"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA",
"organizational_subpart": "NO",
"enumeration_date": "2012-01-25",
"last_updated": "2018-02-07",
"status": "A",
"authorized_official_last_name": "CALDERON",
"authorized_official_first_name": "GLORIA",
"authorized_official_title_or_position": "VICE PRESIDENT, CLINIC OPERATIONS",
"authorized_official_telephone_number": "626-346-2455"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DU4034-EFF. 3/10/12",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "APPROVED EFF 1/31/12",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Golden Shore Medical Group",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.