Provider Demographics
NPI:1699539940
Name:MOLINA, MA LUZ ISABEL MOLINA (PMHNP)
Entity type:Individual
Prefix:
First Name:MA LUZ ISABEL
Middle Name:MOLINA
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 R ST UNIT 409
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6779
Mailing Address - Country:US
Mailing Address - Phone:916-980-6814
Mailing Address - Fax:
Practice Address - Street 1:1720 R ST UNIT 409
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6779
Practice Address - Country:US
Practice Address - Phone:916-980-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028924363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health