MEDICARE: MINAL D TAPADIA MD 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
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1215498282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINAL D TAPADIA MD INC

Provider Business Mailing Address
First Line	:	4 TRAFALGAR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6830
Country	:	US
Telephone Number	:	907-204-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	11170 WARNER AVE STE 106
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4014
Country	:	US
Telephone Number	:	714-540-3244
Fax Number	:	714-540-5842

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MINAL TAPADIA
Credential	:	MD
Telephone Number	:	907-204-1710

Provider Enumeration Date	:	03/30/2019
Last Update Date	:	11/30/2020

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