MEDICARE: MARLON MINERA 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A169462	CA

General Provider Information

NPI Number	:	1306367958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLON MINERA MD

Provider Business Mailing Address
First Line	:	17130 VAN BUREN BLVD # 1007
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-5905
Country	:	US
Telephone Number	:	951-476-3239
Fax Number	:	951-584-3080

Provider Business Practice Location Address
First Line	:	17130 VAN BUREN BLVD # 1007
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-5905
Country	:	US
Telephone Number	:	951-476-3239
Fax Number	:	951-584-3080

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

Provider Enumeration Date	:	07/05/2017
Last Update Date	:	02/23/2026

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