Provider Demographics
NPI:1225202740
Name:MOLINA, DAVID ULISES (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ULISES
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49551
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-9551
Mailing Address - Country:US
Mailing Address - Phone:719-505-6118
Mailing Address - Fax:
Practice Address - Street 1:3455 RINGSBY CT STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4923
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1081029OtherNCCPA