Provider Demographics
NPI:1124707146
Name:MOLINA, DEVON MARIE
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:MARIE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8154 CALLE FANITA
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3941
Mailing Address - Country:US
Mailing Address - Phone:619-244-4361
Mailing Address - Fax:
Practice Address - Street 1:8154 CALLE FANITA
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3941
Practice Address - Country:US
Practice Address - Phone:619-244-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program