Provider Demographics
NPI:1588803837
Name:MOLINA, ROBERTO A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:A
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5750 E HIGHWAY 90 STE 200
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-9113
Mailing Address - Country:US
Mailing Address - Phone:520-263-3979
Mailing Address - Fax:520-263-3977
Practice Address - Street 1:75 COLONIA DE SALUD
Practice Address - Street 2:SUITE 200C
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2487
Practice Address - Country:US
Practice Address - Phone:520-335-2800
Practice Address - Fax:520-335-2964
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ47030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779876Medicaid
AZZ92933Medicare PIN