Basic Information
| Provider Information | |||||||||
| NPI: | 1306153622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINA | ||||||||
| FirstName: | LYNNEA | ||||||||
| MiddleName: | GIBRONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 S OAK KNOLL AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911013418 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2730 SALVIO ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945192599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256828000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 81451 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.