| Molina Medical Group Of Southern California | |
|
15 Sw Everett Mall Way Suite A Everett WA 98204-2715 | |
| (425) 348-6727 | |
| (877) 860-2991 |
| Full Name | Molina Medical Group Of Southern California |
|---|---|
| Speciality | Family Medicine |
| Location | 15 Sw Everett Mall Way, Everett, Washington |
| Authorized Official Name and Position | Gloria Calderon (VICE PRESIDENT-CLINIC OPERATIONS) |
| Authorized Official Contact | 5624917053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Molina Medical Group Of Southern California 200 Oceangate Suite 100 Long Beach CA 90802-4317 Ph: (562) 499-6191 | Molina Medical Group Of Southern California 15 Sw Everett Mall Way Suite A Everett WA 98204-2715 Ph: (425) 348-6727 |
| NPI Number | 1700158417 |
|---|---|
| Provider Enumeration Date | 01/27/2012 |
| Last Update Date | 06/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700158417 | NPI | - | NPPES |
| APPROVED/PROVIDERONE | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Washington) | Primary |
| 207R00000X | Internal Medicine | (Washington) | Secondary |
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