Healthcare Provider Details

I. General information

NPI: 1194899492
Provider Name (Legal Business Name): MINA N MIKHAIL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

IV. Provider business mailing address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

V. Phone/Fax

Practice location:
  • Phone: 951-750-1090
  • Fax: 951-750-1091
Mailing address:
  • Phone: 951-750-1090
  • Fax: 951-750-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA51300
License Number StateCA

VIII. Authorized Official

Name: MINA N MIKHAIL
Title or Position: OWNER
Credential: MD
Phone: 951-750-1090