MEDICARE: PETER MINKOFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G52109	CA

General Provider Information

NPI Number	:	1023090008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MINKOFF M.D.

Provider Business Mailing Address
First Line	:	332 S JUNIPER ST STE 100
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-4249
Country	:	US
Telephone Number	:	760-291-6621
Fax Number	:	760-737-3430

Provider Business Practice Location Address
First Line	:	306 W EL NORTE PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1960
Country	:	US
Telephone Number	:	760-746-3703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	12/01/2020

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