Healthcare Provider Details

I. General information

NPI: 1659312411
Provider Name (Legal Business Name): MINKES & DEERE, M.D.'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE SUITE 111
DOWNEY CA
90241-5010
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE SUITE 111
DOWNEY CA
90241-5010
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-1651
  • Fax: 562-904-1656
Mailing address:
  • Phone: 562-904-1651
  • Fax: 562-904-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG54147
License Number StateCA

VIII. Authorized Official

Name: MRS. RITA K AGUILAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-904-1651