Provider Demographics
NPI:1336913821
Name:MINASYAN, MIASNICK
Entity Type:Individual
Prefix:
First Name:MIASNICK
Middle Name:
Last Name:MINASYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11082 COLOMA RD STE 10
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2875
Mailing Address - Country:US
Mailing Address - Phone:916-638-2363
Mailing Address - Fax:916-638-2364
Practice Address - Street 1:11082 COLOMA RD STE 10
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2875
Practice Address - Country:US
Practice Address - Phone:916-638-2363
Practice Address - Fax:916-638-2364
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter