Provider Demographics
NPI:1316918998
Name:MOLINA, MARIA C (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MA CARMENTCITA
Other - Middle Name:CANLAS
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4730 S FORT APACHE RD
Practice Address - Street 2:SUITE150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7945
Practice Address - Country:US
Practice Address - Phone:702-940-1570
Practice Address - Fax:702-940-1571
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1316918998Medicaid
NV11229OtherSTATE LICENSE
G31626Medicare UPIN
NV1316918998Medicaid
NVGB932ZMedicare PIN
NVV100247Medicare PIN
NV100247Medicare PIN