Provider Demographics
NPI:1710097670
Name:MINAS, EDUARD (MD)
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:MINAS
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 1:4618 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1977
Mailing Address - Country:US
Mailing Address - Phone:323-669-4323
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:#705
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-661-1571
Practice Address - Fax:323-661-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321180Medicaid
CAA32118Medicare ID - Type Unspecified
CA00A321180Medicaid