Basic Information
| Provider Information | |||||||||
| NPI: | 1134311517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINIEL | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10531 4S COMMONS DR | ||||||||
| Address2: | # 166-405 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921273517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773814115 | ||||||||
| FaxNumber: | 8589011461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1759 BELOIT AVE | ||||||||
| Address2: | APT 201 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064731141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A108183 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.