Provider Demographics
NPI:1699234948
Name:MOLINA, TRICIA NGO (DO)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:NGO
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:155 E WARNER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3082
Mailing Address - Country:US
Mailing Address - Phone:480-649-6600
Mailing Address - Fax:
Practice Address - Street 1:33 W TAMARISK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-2422
Practice Address - Country:US
Practice Address - Phone:602-344-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ009574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program