Individual
JERROLD MINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8670 WILSHIRE BLVD STE 101, BEVERLY HILLS, CA 90211-2930
(310) 358-2100
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(805) 522-5940
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G22691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G226910
—
CA
Enumeration date
05/05/2006
Last updated
10/10/2013
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