Basic Information
| Provider Information | |||||||||
| NPI: | 1518212422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | MOLLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2261 ELM ST | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945593721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2344 OLD SONOMA RD | ||||||||
| Address2: | BLDG B | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945593708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072534279 | ||||||||
| FaxNumber: | 7072536090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 08/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.