MEDICARE: MARY ANN MINER, M.D., 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1841452539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY ANN MINER, M.D., INC.

Provider Business Mailing Address
First Line	:	520 S EL CAMINO REAL
Second Line	:	SUITE 204
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1726
Country	:	US
Telephone Number	:	650-348-9800
Fax Number	:	650-401-8514

Provider Business Practice Location Address
First Line	:	520 S EL CAMINO REAL
Second Line	:	SUITE 204
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1726
Country	:	US
Telephone Number	:	650-348-9800
Fax Number	:	650-401-8514

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY ANN MINER
Credential	:	M.D.
Telephone Number	:	650-401-8513

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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