Doctor Name: | BRIAN JOSEPH MINNILLO |
NPI Number: | 1104142389 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | RP887426 |
Business Practice Address: | 9850 Genesee Ave Ste #440 La Jolla, CA - 920371224 |
Business Phone Number: | 8584535944 |
Business Fax Number: | 8584297926 |
Mailing Address: | Po Box 33865, SAN DIEGO |
State: | CA |
Postal Code: | 921633865 |
Phone Number: | 8588887700 |
Fax Number: | 8585008021 |
NPI Enumeration Date: | 04/13/2010 |
NPI Last Update Date: | 03/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | RP887426 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |