Provider Demographics
NPI:1033689070
Name:MOLINA, CYNTHIA G
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
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 1:2740 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2069
Mailing Address - Country:US
Mailing Address - Phone:503-688-2595
Mailing Address - Fax:503-238-4716
Practice Address - Street 1:2740 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2069
Practice Address - Country:US
Practice Address - Phone:503-688-2595
Practice Address - Fax:503-238-4716
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program