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1174570931

NPI Code Detail

MEDICARE: NIDA NORA E MINIANO MD

MEDICARE: NIDA NORA E MINIANO MD

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	A88182	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01222611/DS9933	OTHER	CA	RR MEDICARE-CITRUS HEIGHTS, 55TH ST
3	P01453284-DV5277	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ACTIVE EFF: 12/21/09	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1174570931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDA NORA E MINIANO MD

Provider Business Mailing Address
First Line	:	8233 E STOCKTON BLVD
Second Line	:	STE D
City	:	SACRAMENTO
State	:	CA
Zip	:	95828-8203
Country	:	US
Telephone Number	:	916-368-3080
Fax Number	:	916-405-6551

Provider Business Practice Location Address
First Line	:	8233 E STOCKTON BLVD STE D
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95828-8203
Country	:	US
Telephone Number	:	916-368-3080
Fax Number	:	916-405-6551

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/21/2022

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Directions to “ NIDA NORA E MINIANO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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