Provider Demographics
NPI:1487931267
Name:MOLINA, LUISITA B (RW)
Entity type:Individual
Prefix:MS
First Name:LUISITA
Middle Name:B
Last Name:MOLINA
Suffix:
Gender:F
Credentials:RW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N ALVARADO ST
Mailing Address - Street 2:1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4987
Mailing Address - Country:US
Mailing Address - Phone:213-804-8884
Mailing Address - Fax:
Practice Address - Street 1:128 N ALVARADO ST
Practice Address - Street 2:1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4987
Practice Address - Country:US
Practice Address - Phone:213-804-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS6383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)