Provider Demographics
NPI:1487341343
Name:MOLINA, RUSSELL HENRY
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:HENRY
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75150 SHERYL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5118
Mailing Address - Country:US
Mailing Address - Phone:760-345-4779
Mailing Address - Fax:
Practice Address - Street 1:75150 SHERYL AVE STE A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5118
Practice Address - Country:US
Practice Address - Phone:949-241-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist