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NPI Code Detail

MEDICARE: MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIFORNIA INC

MEDICARE: MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIFORNIA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor
21041C0700XClinical Social Worker
3106H00000XMarriage & Family Therapist
4363LF0000XFamily Nurse Practitioner

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DO3845OTHERCAMEDICARE RAILROAD

General Provider Information

NPI Number : 1033309372
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIFORNIA INC
Provider Business Mailing Address
First Line : PO BOX 772
Second Line : PAYOR ENROLLMENT-MC 2295
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Provider Business Practice Location Address
First Line : 511 N HOLLYWOOD WAY
Second Line :
City : BURBANK
State : CA
Zip : 91505-3406
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH PINCINCE
Credential :
Telephone Number : 401-770-3813
Provider Enumeration Date : 08/01/2007
Last Update Date : 10/11/2024

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