Basic Information
| Provider Information | |||||||||
| NPI: | 1396343703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINA | ||||||||
| FirstName: | CATYA | ||||||||
| MiddleName: | JEANNETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23501 CINEMA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 S C ST | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930334560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055097852 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2020 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 104727 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 104727 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | 104727 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.