Basic Information
| Provider Information | |||||||||
| NPI: | 1063446953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINA | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOLINA | ||||||||
| OtherFirstName: | RICARDO | ||||||||
| OtherMiddleName: | ANTONIO | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 39350 CIVIC CENTER DR. STE. 300 | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973922 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Practice Location | |||||||||
| Address1: | 39350 CIVIC CENTER DR. STE. 300 | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973922 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | A108732 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.