NPIMap

Organization Active NPI

Molina Healthcare of California

Doing business as Molina Medical Centers

  • Non-Pharmacy Dispensing Site
  • W Sacramento, CA
National Provider Identifier
1952516288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
MOLINA HEALTHCARE OF CALIFORNIA
Doing business as
Molina Medical Centers
Practice address
Molina Medical Centers - Smo
954 Sacramento Avenue
W. Sacramento, CA 95605-1904
Phone
(916) 373-1495
Fax
(916) 373-0954
NPI assigned
May 11, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dennis Wayne Evans
Title
Strategic Planner, Research & Dev.
Phone
(562) 499-6191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

Molina Medical Centers - Smo
954 Sacramento Avenue
W. Sacramento, CA 95605-1904

Mailing address

Molina Medical Centers - Smo
One Golden Shore
Long Beach, CA 90802-4202
Phone (562) 499-6191

Other identifiers 1

IdentifierTypeStateIssuer
GR004265MMedicaidCA

Other names 1

  • Molina Medical Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Molina Healthcare of California11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952516288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MOLINA MEDICAL CENTERS - SMO",
            "address_2": "ONE GOLDEN SHORE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024202",
            "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": "MOLINA MEDICAL CENTERS - SMO",
            "address_2": "954 SACRAMENTO AVENUE",
            "city": "W. SACRAMENTO",
            "state": "CA",
            "postal_code": "956051904",
            "telephone_number": "916-373-1495",
            "fax_number": "916-373-0954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA HEALTHCARE OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "STRATEGIC PLANNER, RESEARCH & DEV.",
        "authorized_official_telephone_number": "562-499-6191",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR004265M",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Molina Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in W Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.