Provider Demographics
NPI:1245414242
Name:MINAKA, INC
Entity Type:Organization
Organization Name:MINAKA, INC
Other - Org Name:THE SHOE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHAEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-455-0404
Mailing Address - Street 1:24102 EL TORO RD STE I
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3123
Mailing Address - Country:US
Mailing Address - Phone:949-455-0404
Mailing Address - Fax:
Practice Address - Street 1:24102 EL TORO RD STE I
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-3123
Practice Address - Country:US
Practice Address - Phone:949-455-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6055880001Medicare NSC