Provider Demographics
NPI:1386339422
Name:MICHAEL R MOLLURA PH.D. PSYCHOLOGIST INC., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL R MOLLURA PH.D. PSYCHOLOGIST INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLURA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:213-280-9625
Mailing Address - Street 1:9730 WILSHIRE BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2004
Mailing Address - Country:US
Mailing Address - Phone:213-280-9625
Mailing Address - Fax:
Practice Address - Street 1:9730 WILSHIRE BLVD STE 216
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2004
Practice Address - Country:US
Practice Address - Phone:213-280-9625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty