Provider Demographics
NPI:1194899492
Name:MINA N MIKHAIL MD INC
Entity type:Organization
Organization Name:MINA N MIKHAIL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-750-1090
Mailing Address - Street 1:4500 BROCKTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4006
Mailing Address - Country:US
Mailing Address - Phone:951-750-1090
Mailing Address - Fax:951-750-1091
Practice Address - Street 1:4500 BROCKTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4006
Practice Address - Country:US
Practice Address - Phone:951-750-1090
Practice Address - Fax:951-750-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513000Medicaid
CA00A513000Medicare ID - Type Unspecified
F65678Medicare UPIN