MEDICARE: DR. NICHOLAS JOSEPH MINIEL MD

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
1	207P00000X	Emergency Medicine Physician	A108183	CA

General Provider Information

NPI Number	:	1134311517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS JOSEPH MINIEL MD

Provider Business Mailing Address
First Line	:	10531 4S COMMONS DR
Second Line	:	# 166-405
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3517
Country	:	US
Telephone Number	:	877-381-4115
Fax Number	:	858-901-1461

Provider Business Practice Location Address
First Line	:	1759 BELOIT AVE
Second Line	:	APT 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4257
Country	:	US
Telephone Number	:	206-473-1141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	09/13/2021

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