Provider Demographics
NPI:1760813521
Name:MOLINA, RYAN P (CO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:MOLINA
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2824 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3400
Mailing Address - Country:US
Mailing Address - Phone:626-431-2890
Mailing Address - Fax:626-431-2892
Practice Address - Street 1:2824 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3400
Practice Address - Country:US
Practice Address - Phone:626-431-2890
Practice Address - Fax:626-431-2892
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACO0038231744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO003823OtherAMERICAN BOARD ACCREDITATION (ABC) ORTHOTIST