Provider Demographics
NPI:1982995916
Name:TAPADIA, MINAL DILEEP
Entity Type:Individual
Prefix:
First Name:MINAL
Middle Name:DILEEP
Last Name:TAPADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TRAFALGAR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6830
Mailing Address - Country:US
Mailing Address - Phone:907-204-1710
Mailing Address - Fax:
Practice Address - Street 1:11170 WARNER AVE STE 106
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4014
Practice Address - Country:US
Practice Address - Phone:714-540-3244
Practice Address - Fax:714-540-5842
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130784207X00000X
CAA122836207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0982150OtherCIGNA
FL020492000Medicaid
FLX0XCKOtherFL BCBS