Provider Demographics
NPI:1861426850
Name:MINASAKANIAN, BERJ K (MD)
Entity type:Individual
Prefix:
First Name:BERJ
Middle Name:K
Last Name:MINASAKANIAN
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:PO BOX 20020
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-0020
Mailing Address - Country:US
Mailing Address - Phone:562-809-3564
Mailing Address - Fax:
Practice Address - Street 1:2701 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-0240
Practice Address - Country:US
Practice Address - Phone:714-754-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A298690Medicaid
CAAN605ZMedicare PIN
A25895Medicare UPIN
CA00A298690Medicaid