Provider Demographics
NPI:1659312411
Name:MINKES & DEERE, M.D.'S
Entity Type:Organization
Organization Name:MINKES & DEERE, M.D.'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-904-1651
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5010
Mailing Address - Country:US
Mailing Address - Phone:562-904-1651
Mailing Address - Fax:562-904-1656
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5010
Practice Address - Country:US
Practice Address - Phone:562-904-1651
Practice Address - Fax:562-904-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54147208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00080690Medicaid
CAZZZ54573ZOtherBLUE SHIELD
CAGR0080690OtherMEDI-CAL
CAGR00080690Medicaid