Provider Demographics
NPI:1336714401
Name:MOLINA HEALTHCARE OF NEVADA, INC
Entity type:Organization
Organization Name:MOLINA HEALTHCARE OF NEVADA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTERDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-233-1076
Mailing Address - Street 1:200 S VIRGINIA ST FL 8
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2403
Mailing Address - Country:US
Mailing Address - Phone:562-435-3666
Mailing Address - Fax:562-951-1505
Practice Address - Street 1:200 S VIRGINIA ST FL 8
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2403
Practice Address - Country:US
Practice Address - Phone:562-435-3666
Practice Address - Fax:562-951-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization