Provider Demographics
NPI: | 1457643595 |
---|---|
Name: | MINEYEV, NEAL MARTIN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NEAL |
Middle Name: | MARTIN |
Last Name: | MINEYEV |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2233 STOCKTON BLVD., HOUSESTAFF BUILDING ROOM 2025 |
Mailing Address - Street 2: | |
Mailing Address - City: | SACRAMENTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95817 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-734-7293 |
Mailing Address - Fax: | 916-734-6564 |
Practice Address - Street 1: | 2233 STOCKTON BLVD., HOUSESTAFF BUILDING ROOM 2025 |
Practice Address - Street 2: | |
Practice Address - City: | SACRAMENTO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95817 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-734-7293 |
Practice Address - Fax: | 916-734-6564 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-09 |
Last Update Date: | 2020-08-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
CA | A132040 | 208600000X, 204F00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |