Provider Demographics
NPI:1720960784
Name:MOLINA, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NORTHRIDGE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-2762
Mailing Address - Country:US
Mailing Address - Phone:580-377-3599
Mailing Address - Fax:580-254-5335
Practice Address - Street 1:316 NORTHRIDGE CIR STE 3
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2762
Practice Address - Country:US
Practice Address - Phone:580-377-3599
Practice Address - Fax:580-254-5335
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist