Healthcare Provider Details

I. General information

NPI: 1033006309
Provider Name (Legal Business Name): MARLON MINERA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6376 GREYSON WAY
RIVERSIDE CA
92506-5333
US

IV. Provider business mailing address

17130 VAN BUREN BLVD # 1007
RIVERSIDE CA
92504-5905
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-5087
  • Fax:
Mailing address:
  • Phone: 951-289-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLON GEOVANNY MINERA
Title or Position: PRESIDENT
Credential: MD
Phone: 951-289-5087