Provider Demographics
NPI:1225479728
Name:MOLINA, MISTY MICHELLE (CNM, ARNP, WHNP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:CNM, ARNP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 RUDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5060
Mailing Address - Country:US
Mailing Address - Phone:805-298-9660
Mailing Address - Fax:
Practice Address - Street 1:11239 TAMPA AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-3778
Practice Address - Country:US
Practice Address - Phone:253-376-9070
Practice Address - Fax:833-740-3507
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707832363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health