Basic Information
| Provider Information | |||||||||
| NPI: | 1760446926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINA | ||||||||
| FirstName: | SALVADOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 BLUE LAGOON DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615705172 | ||||||||
| FaxNumber: | 7864725770 | ||||||||
| Practice Location | |||||||||
| Address1: | 10435 VISTA DEL SOL DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155916229 | ||||||||
| FaxNumber: | 9152066385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3404 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | L3404 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1557035-11 | 05 | TX | MEDICAID | P10334424 | 01 | TX | RAILROAD RETIREMENT MEDICARE | OTHER | 95706810 | 05 | NM | MEDICAID | 8DZ246 | 01 | TX | BC/BS OF TEXAS | OTHER |