Provider Demographics
NPI:1336226786
Name:MIKHAIL, MINA N (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:N
Last Name:MIKHAIL
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 1:4100 CENTRAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-750-1090
Mailing Address - Fax:951-750-1091
Practice Address - Street 1:4100 CENTRAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2933
Practice Address - Country:US
Practice Address - Phone:951-750-1090
Practice Address - Fax:951-750-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513000Medicaid
F65678Medicare UPIN
CA00A513000Medicaid