MEDICARE: CARRIE R MINNELLI 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	207R00000X	Internal Medicine Physician	MD60652584	WA
2	207RN0300X	Nephrology Physician	MD60652584	WA
3	207RN0300X	Nephrology Physician	A123820	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518299411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE R MINNELLI MD

Provider Business Mailing Address
First Line	:	3660 PARK SIERRA DR STE 203
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3071
Country	:	US
Telephone Number	:	951-687-3400
Fax Number	:	951-687-7630

Provider Business Practice Location Address
First Line	:	1100 N PALM CANYON DR STE 211
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4426
Country	:	US
Telephone Number	:	951-687-3400
Fax Number	:	760-325-8629

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	08/16/2021

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Directions to “ CARRIE R MINNELLI MD” Practice Location

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