Provider Demographics
NPI:1093515678
Name:MOLINA, ANNIE (MS, RD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:MOLINA
Suffix:
Gender:
Credentials:MS, RD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:LITTLE-MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1629 E ECLIPSE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1480
Mailing Address - Country:US
Mailing Address - Phone:559-905-0449
Mailing Address - Fax:
Practice Address - Street 1:7300 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2941
Practice Address - Country:US
Practice Address - Phone:559-448-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86168629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered