Provider Demographics
NPI:1922757145
Name:MCLAREN, MOLLY MICHELLE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MICHELLE
Last Name:MCLAREN
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 1:2587 ESCALA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4769
Mailing Address - Country:US
Mailing Address - Phone:561-371-6754
Mailing Address - Fax:
Practice Address - Street 1:765 THIRD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5842
Practice Address - Country:US
Practice Address - Phone:619-765-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN95168148163WC0200X
CA95023458363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine