Provider Demographics
NPI:1104880616
Name:MOLINA, NANCY (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 CAMINO DE LOS MARES 226
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2860
Mailing Address - Country:US
Mailing Address - Phone:949-248-2826
Mailing Address - Fax:949-248-2815
Practice Address - Street 1:647 CAMINO DE LOS MARES 226
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2860
Practice Address - Country:US
Practice Address - Phone:949-248-2826
Practice Address - Fax:949-248-2815
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57738OtherAMERICAN SPECIALTY HEALTH
CA2507809OtherAETNA HMO/POS
CADC0233250Medicaid
CA0004610391OtherAETNA TRAD/EPO
CA0004610391OtherAETNA TRAD/EPO
CA2507809OtherAETNA HMO/POS