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General NPI Number Information
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NPI Number | 1194899492
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Entity Type | Organization
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Legal Business Name | MINA N MIKHAIL MD INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 4500 BROCKTON AVE STE 203
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City | RIVERSIDE
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State | CA
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Zip | 92501-4006
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Country | US
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Telephone | 951-750-1090
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Fax | 951-750-1091
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Provider Business Mailing Address
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Address Line | 4500 BROCKTON AVE STE 203
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City | RIVERSIDE
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State | CA
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Zip | 92501-4006
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Country | US
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Telephone | 951-750-1090
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Fax | 951-750-1091
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Authorized Official
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Title or Position | OWNER
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Name | MINA N MIKHAIL
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Credential | MD
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Telephone | 951-750-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A51300
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License Number State | CA
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