MEDICARE: MINTESINOT EDEA BIRBO

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	344600000X	Taxi

General Provider Information

NPI Number	:	1962971010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINTESINOT EDEA BIRBO

Provider Business Mailing Address
First Line	:	538 SAINT JAMES ST
Second Line	:
City	:	COLUMBIA
State	:	VA
Zip	:	23038-2891
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	538 SAINT JAMES ST
Second Line	:
City	:	COLUMBIA
State	:	VA
Zip	:	23038-2891
Country	:	US
Telephone Number	:	804-955-0843
Fax Number	:

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

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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Directions to “ MINTESINOT EDEA BIRBO ” Practice Location

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