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General NPI Number Information
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NPI Number | 1538482286
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Entity Type | Organization
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Legal Business Name | GREGORY A. MINEVICH M.D. PROFESSIONAL CORP
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 1290 B ST STE 305
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City | HAYWARD
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State | CA
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Zip | 94541-2967
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Country | US
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Telephone | 510-582-8281
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Fax | 510-582-4557
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Provider Business Mailing Address
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Address Line | 1290 B ST STE 305
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City | HAYWARD
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State | CA
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Zip | 94541-2967
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Country | US
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Telephone | 510-582-8281
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Fax | 510-582-4557
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MONIKA L KING
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Credential |
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Telephone | 510-582-8281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A93150
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License Number State | CA
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