Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO0057 | CA |
N | 222Z00000X | Podiatrist | CPO0057 | CA |
Y | 224P00000X | Prosthetist | CPO00577 | CA |
N | 225000000X | Orthotic Fitter | CPO0057 | CA |
NPI | 1245475748 |
---|---|
Provider Name | Roger Molina |
First Address | Tracy, CA 95304-9314 |
Second Address | Modesto, CA 95350-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 10/02/2012 |